Slashdot Mirror
High Tech Medical Clinics?
Bolus asks: "I am a physician who is setting up a new adult medicine clinic with several other physicians. We are designing our clinic from the ground up with the latest computer technology. This will include computers in every exam room, a paperless electronic medical record, and a T1 for Internet access. Patients will have the ability to e-mail their physician and access parts of their chart online, such as medications and labs. What other kinds of online service would you want your doctor's office to offer? Instant messaging to your physician? A bulletin board for general medical questions? Chat groups? Video conferencing?"
I'd just like to chime in to emphasize this point in a US-specific way. My understanding is that new laws are going to make health care providers liable, both in civil and criminal terms, for protecting patients' medical records.
You should very carefully look into this, and consult with a health-care attorney, before giving any outside access to patients' medical records. Personally, I would just not do it. It's going to be a while before a reasonable standard of protection of medical records privacy is established. Until then, I'd leave the legal bleeding edge to the megacorporations with deep pockets.
And you are a poor lawyer who gives all his excess income to the poor I presume.
Should we really be supporting this kind of behaviour?
Well, at least now you are given a choice. You already help the poor with your taxes and with the charities you contribute to (which I am sure you do, otherwise you wouldn't be posting this). Are you suggesting that we spend every spare dime we have on helping the poor? If so, why work as hard as we do in order to make that extra money?
These guys don't want to talk about any real uses of technology in medicine, like for curing people. They just want to pad their fees in order to squeeze yet more $$$
Well, that is the general idea, yes. I try to earn as much as possible from my work as well and I don't think there is anything wrong with that. As a matter of fact I think it is good, even for the poor: the more I earn, the more taxes I pay.
Everyone's down on lawyers, but we're freakin' little league parasites compared to this kind of doctor.
Nope. Lawyer are parasites by definition: they don't create value. You only need lawyers because the opposition has lawyers. Same thing applies to people in marketing, PR etc. This doctor saves lives, and I am willing to pay for that.
I'm a developer at a company that creates electronic medical records, scheduling/billing systems, etc. that are used at large healthcare enterprises. In fact, not knowing where "Bolus" is from, there might even be a chance that he is talking about our software :)
:)
Anyway, I am willing to bet that Bolus wasn't talking about "real" email. It's just easier to say "email" than to say "web-based secure messaging system". Our software and the software of most/all of our competitors has a messaging system that allows patients and clinicians (rarely will it be the actual doctor) to communicate in a secure manner. The patient creates and reads messages only within SSL encrypted browser sessions. Messages do not ever really leave the facility (except over these SSL sessions), and certainly not as plaintext SMTP email. Many products do support SMTP email "ticklers" that basically say: "You've got a message, please log in to read it".
Not only is this security common sense, it's required by law. Patient identifiable information can not be transmitted over the internet in plaintext whether it is a list of your current diagnoses or whether it is just that you have an appointment comming up at the HIV clinic. You get the point. Any organization who is using traditional email for this is asking for trouble and an article describing the lawsuit agains them in the wall street journal
Security.
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One that would be nice to have is a video link to the hospital. This would allow either EMS workers to "show" a doctor something they aren't sure how to handle, or alternately, a public link that patients can connect through and show a nurse to help them decide what to do. The nurse can either summon a doctor for help, refer them to a local clinic, tell them to bring the patient to emegency, and/or dispatch an ambulance to them. In addition, the nurse can tell the people what to do to make the patient more confortable and/or help save their life...like making sure the patient is kept warm, don't pull out the knife, etc. Many people in crisis situations forget their basic first aid, if they ever had it. First aid saves lives.
ttyl
Farrell
CAN-CON 2019 - Ottawa's only book oriented Science Fiction Convention! October 18-20, Sheraton Hotel, Ottawa, Canada h
It's the insurance company cap on what they will pay (this is MD, folks. Might be better or worse elsewhere). But the costs didn't go down. Now the doc is taking home around $50 per hour.
That is a problem. The doctor bears the brunt of the cost caps because he is the public face of medicine. In a more fair system, as the doctor's fees were capped, his costs for supplies and insurance would also be capped. Pardon the analogy, but it's a case of treating the symptoms rather than the disease.
"If you don't wany to pay a doctor for medical help and advice, then go to medical school and you won't have to. "
That's a ridiculous suggestion! There's no way you can go to school to be trained for everything that you don't want to be ripped off over. IMHO, a modern society should provide the basics of all necessities, which includes free health care for all.
...in deciding what and how to computerize.
My druggist just added a web site for ordering refills. I was leery of it until I visited---all they ask for is your name and prescription number, which is then *faxed* to them. The prescription info is not in an Internet-connected system. They use HTTPS for the entry, which is nice, but even better is the fact that any evesdropper will have exactly zero useful info. To know what's going on would require social engineering or a breakin to either the drugstore or my home, at which point any computer involvement is moot.
So, examine your transactions carefully---you can increase security with good choices of what data to expose.
Oh, yeah, and build in checks, as has been pointed out elsewhere. The first time I used their new system, I entered a typo. Within minutes a pharmacist was on the line verifying what I really wanted.
I refuse to believe corporations are people until Texas executes one. -- desert rain on http://www.dailykos.com/user/
Unless you and your patient
- only use computers which run the software to actually ship the mail across the net (a Mail Transfer Agent, or MTA, and hint: the web browser that lets you access your e-mail ain't one), and
- keep those computers connected to the net 24x7 so your two MTAs can talk directly to each other whenever they wish, and
- happen to avoid sending traffic through any system (your ISP's, their backbone provider's, or any random router somewhere) on which the sysop is examining traffic for tuning, debugging, or pure enjoyment,
there's gonna be lotsa folks who can read your e-mails.And don't forget any system on which the mail resides momentarily while a backup is in progress (limited by point 1, above, to the two endpoints, but if you slip up...). That means there's a copy of said mail stashed more-or-less permanently on some mag. tape in some unknown person's hands.
There's really a lot to be said for paper. If you insist on digitizing your practice, then don't let any of your systems connect to the Internet, directly or indirectly. (''Oh, we'll just send this to Dr. Kildare, on a floppy---that's safe, right?'' Yeah, until someone breaks into his system.)
I refuse to believe corporations are people until Texas executes one. -- desert rain on http://www.dailykos.com/user/
I would *love* to be able to look at his calendar, just to see what times are already taken, before calling for an appointment.
Email reminders about appointments would be nice too.
Not all doctors are schmucks, just like not all lawyers are schmucks. Find a good one and work with him.
yadda
Firstly, I think a lot of people are reluctant to bring up this issue with their physicians but I'm a forthright sort of person and now that I'm a contractor I'm additionally substantially more aware of how my time is expended (and on this day I *could* have worked an additional hour for a client rather than sitting in the waiting room). This costs me money and I don't like it. I would think that it would be a simple matter of:
It isn't clear why "high tech" needs to be involved to address this issue but should it assist in eliminating it I'm all for it. I realize estimating is hard (I have to do it in my profession all the time) but over the years I've developed a multiplier that I use to account for interruptions/distractions/unforseen problems and as a result my estimates tend to be pretty accurate - surely the variability involved in seeing patients in a timely fashion could be handled in a similar way
there are two kinds of people in this world - those who divide people into two groups and those who don't
First, go to the OpenHealth website, where they're working on some of this stuff.
Second, if you're in the US, get acquainted with the Health Insurance Portability and Accountability Act (HIPAA) and associated regulations. This means you need to design interfaces to open standards, and, more importantly, design the security first, everything else second (as in massive fines for messing up security so non-authorized people get access to records).
Second opinion. Give your customer a choice even if the choice is not you. That show not only you are hip but care for the well being of your client.
'Please state the nature of the medical emergency.'
The ability to book an appointment without having to go through a receptionist; links to information sites on common afflictions; links to local support organisations and healthcare businesses (e.g. pharmacies); a repeat prescription system, and of course, linux advocacy. 9 out of 10 doctors prefer it !
It's all very well in practice, but it will never work in theory.
I wonder what kind of security any of your services will offer? Leaving files (charts) of the type you are discussing open on the internet is just asking to have the script kiddies hammering away on it.
Vip
These guys are trying to make common medicine more accessible. They hope to keep their patients in better contact, and this is a good thing.
If I can communicate with my doctor electronically, I might tell him things more often about the state of my health. Like things I would tell the doctor if I were living in some small town in Kansas, and saw him in the street.
Say I complain about specific leg pain sometimes, and minor twitches in my back at others. Or say I regularly report I wake up with a stuffy head, or that (god forbid at 25) have regular bowel problems. This might tell a doctor something else.
These are not things I would schedule a doctor's appointment for - and things I may not remember at a sporadic physical exam - but they are things a doctor may be able to help me with.
Better communication with physicians will help us all live longer, and I for one would be willing to pay for it in higher insurance premiums.
As for the lexus, don't you have one too?
-jonbrewer
Hmmm, I'd be a bit wary about a BB service.
All it would take is one patient mis-quoting you (or another MD) and it's lawsuit time. You would probably have to have some _major_ disclaimers or some kind of click-agreement (not to use the BB in place of a real doctors advice).
signal, noise, to me it's all the same.
I couldn't agree more. When you are vomiting, runing a high fever, and dizzy, you should not be sitting for 2.75 hours in a doctor's office. This is percisely what happened over Christmas with my girlfriend...she was feeling very bad, and we had to wait: 2.75 hours!!!!!!! We saw the doctor for 5-8 min at most.
Run the office like a real business. If I had clients schedule a meeting at my office and they had to wait for 2.5 hours, I would have lost the sale at around 25-40 min...it would have gone somewhere else in a hurry!
Doctors: PLEASE have your office staff just schedule things ON TIME!
-JL
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Sig Return: 204 No Content
Patient record confidentiality must be an absolute design goal from the inception of the project. The only way to be truly certain is to employ an "air-gap" firewall, In other words, don't put confidential information on any system connected to any network that can be accessed by non-authorized individuals. The military has significant experience with that, and I would urge you to hire security consultants with experience in such matters. Reply to this message if you are interested, and I can put you in touch with one outfit with the requisite experience.
I think the integration of information and sequencing of information is central.
In a hospital setting you should be able to see results of blood samples, see the ecg or eeg and even see x-rays directly on screen without to much fiddling around in different applications.
The sequencing side is the possibility to see e.g. blood sugar level through the last 5 years in one screen.
These system do exist, I am not aware of any of them in the US (I live in Europe)
Use the EMR as a teaching / educational tool. I have seen computers seen as a threat to the patient-doctor interaction, but I see it as a huge opportunity to enage the patient with the doctor. If the EMR is considered a tool to communicate and build together, then it will help the patient understand the condition and the illness at hand. Make sure the patient sees you (the doctor) enter things into the computer so they know what you are writing and can indeed verify that it is accurate. Give them print outs of your diagnosis and treatment plans -- often they are too complex to convey quickly and thoroughly.
I would say that you should stay away from remote access of files / records. This isn't as important as good communication.
Stay away from diagnosis-by-email -- good patient interaction can't happen over the phone or email, so don't try. Bring them in and explain why you need to _see_ them.
Focus using computers where they are good at -- record keeping, planning and calculation. As others mentioned, use them to schedule appointments, keep records, and plan out the treatment regimine.
Just my thoughts.
Colin
a web page, with a simple bio, discussion of education and philosophy, and some faqs like: how many patients do you see have symptoms that are caused completely by stress? What are these symptoms? (and when a doctor says 'seizures' here, I'll know to avoid them..)
Why? Because I"m sick of paying $100+ to discover that my dermatologist doesn't realize that asthma and hayfever are related to eczema, and all three are allergic reactions, my doctor wants to give me prozac for those allergic reactions, since allergies are caused by 'stress', my gyne is telling me I have HPV because she coudln't be bothered to tell me that using tampons before a PAP smear messes it up (she knew which day of my cycle it was, too..) (and no, I don't have HPV, but I had to spend $500 for a biopsy to be sure) or that my (yet another) doctor has decided that tylenol 3 is a really good long-term headache management plan (any headache that requires codeine to kill off that lasts more than three weeks is scary to me -- Turned out I'd just given myself a concussion, but doc #1 couldn't be bothered to figure that out).
Never mind the friend's daughter who has been told repeatedly that her seizures were 'psychological' and been sent to therapists for a year -- finally my friend took her to Stanford -- she has epilepsy!
I'm thinking mandatory informational advertisement could be a good thing, here.
I purchase a lot of doctor's services. so far, in all but one case, the doctor has written his notes on paper.
I will probably refuse to consult a doctor that keeps his notes on a computer, because of the privacy issue. but if I ever decide that my privacy is worth gambling with, then I sure as hell want the copy of the records that *I* get (which I'm entitled to under law) in electronic form, too, not on paper, and not in some proprietary format.
the one security measure that would impress me is if the doctor's office or clinic kept my name, address, phone number, SSN and other "identifying" info on paper. then the computer records by themselves do not betray very much.
Right now, HIPPA guidelines can be met with 128-bit SSL and user id/passwords. In the not-too-distant future, HIPPA will begin require 'non-repudiated' authentication. This means the use of X.509 browser certificates for access to medical data and S/MIME for emails (OK, you could use PGPmail and some kind PGP Java authentication system, but that's quite unwieldy). While a small medical clinic may be able to setup a Certificate Authority (CA), you may need to use Verisign or another large CA to issue these certificates. But you're biggest stumbling block is user support. Installing browser certificates and educating the user on the safe use of certificates is quite a challenge.
And that is how people decide to become doctors...but then they realize that the doctor does not get all that money. Have you ever looked at the facility you are sitting in when you are at the Dr. office? It tends to cost quite a bit of money. Now what about all those nurses, and secretaries, etc. they cost too, not to mention equipment supllies etc. Anyway. A Doctor with a private practise can take home as much as a million a year, but that is rare. The Doctor's I knew(working at a medical school) made between about 100,000 and 250,000 dollars. and that is after their residency. During residency, they made about 30 thousand dollars, and were paying medical school bills, which generally were into the 100's of thousands of dollars.
In other words a tech worker is out of school at say 22, and making around 35,000-40,000 to start-by the time they are 30 they are making as much as 100,000-150,000, if they are lucky, and making more all the time, wheras a doctor at the same age is just starting out, and still has school bills to pay!
Of course all the Doctor's i knew were perfectly willing to live like they made 4X as much as they actually did, and were constantly in debt.
;-}
Slackware: old school feel, new school gear.
that's an lot of awfully nasty things to say about these doctors, without necessarily any provocation! which brings me to a small observation that i have, having worked in the medical profession for a few years:
patients are grumpy, they're upset, they don't like what you tell them, and nothing will do. why is this? because they're ill. ill people are not happy people.
the fact that general practitioners in particular survive so many years of this never ceases to amaze me. the fact that they can maintain their sympathy, and try to do their best for each patient, is frankly quite stunning, in the face of the abuse and negativity they see directed towards them often daily. and you sir, have displayed quite nicely some of it.
any profession has the right to try and offer a high end service that will be charged for appropriately. that's what these doctors are obviously attempting to do. at the other end of the spectrum their will be (or should be, depending on how fucked your country is) affordable no-bells-and-whistles medical care for those that need it.
let them offer a high end service. there are people out there with the money who want to pay for it.
matt
sorry? i fail to see the point you're making. perhaps i should have ignored you altogether.
i presume nhs stands for 'national health service', a government funding of health providers in your country? well i can tell you this: in the country i live in, the government funding covers perhaps 30% of the consultation fee. and there is no government funding for medical materials, a cost the patient often doesn't see. which is just touching the surface of a much larger issue.
again, i'm not sure of your point, so perhaps i should have ignored you.
matt
A lot of people talked about privacy and email from a doctor.
Another big concern is non-repudiation. I, the patient, need to be positive that the email came from my doctor. The doctor should want to be sure that only the patient can receive the email. This is why PGP email was suggested in earlier posts. Imagine what could happen if I got used to receiving clear-text emails from my doctor.
Worst-case-scenario: Somebody intercepts my HIV test results that say I'm positive for the virus. The message gets modified before I receive it to say that my HIV test was negative.
A lot of posts bring up security, so as somebody who actually worked
on an electronic medical record several years ago, here is one of the primary
problems with implementing security:
Docs (and other people with high opinions of themselves and their time)
don't want to have to type in their username/password everytime
they approach a machine (in the hallway, at the nurse's station, in the docs
lounge) to retrieve/update patient info. If they have to key this in all the
time, you will have a bunch of pissed off users who don't even use/like the
application.
With much hindsight, I realize the solution is some kind of security card
or pin containing a microchip that will authenticate the user via
RF transmissions. I think Micron makes these things. It's not a perfect
solution, but it will certainly go over better than having to key in junk
all the time. If anybody has implemented a system like this, I'd be
interested to hear what pros/cons you discovered once it was pressed into
service.
As someone who recently spent many days in a hospital, I have a few suggestions. My biggest problem, by far, was boredom. If I had full internet access, I could have been at least using my mind while I was laying on my back wasting time. Really it was a major problem for me. The damn TV was driving me crazy. And you have to understand, there is nothing else to do. I was in too bad a shape to even walk around.
Now some pundits might suggest that I read books, but you have to understand when I was taken to the hospital, I did not expect it. I was rushed pretty much immediately and had no time to prepare. I don't read books very often these days anyway and a little stop off at the bookstore was totally out of the question.
The other problem was getting the nurse's attention. They had this big red emergency panic button and that's it. I had no way to prioritize my request for a nurse. Having the ability to chat to someone would have been great. That person could then prioritize the help requests in a rational manner rather than first come first serve. I mean sometimes I simply wanted a glass of water and didn't want to wait a few hours for the nurse to come by randomly. But my only choice was to push the panic button. Sometimes it took 15 minutes for someone to show up - I'm glad it wasn't a real emergency then!
Finally I had many, many questions about my condition. The rare times my doctor did show up, I had few, if any, questions because of the pain killing drugs reducing my alertness. Being able to email my doctor, and my surgeon, with questions as I thought of them would have been great.
All sys get cracked in time so make it secure as mentioned but use some failsafe methods also.
I would make the patient records online an opt-in item and or on a rotating basis for those who may need it (chronic care) along with login disclaimers and signed paperwork at opt-in.
I was in an office that had a sys in every room and I had time(had I wanted to) to fool with them; put two people in the room(look-out and tinkerer) and you have a problem.
just my 2 cents
Hmm. On second thought, I lied. I don't have as many years of education. My market value is higher, though. And I don't idle people in my present job the way I would have in my last one. Anyway, my point is that nobody is immune from courtesy.
check out http://marinau.www.media.mit.edu/people/marinau/Pe diatricSocietyAbstract.html for an example of how a chat room can help with mental and physical well being and increased comfort for patients.
Even a simple chat room (like http://chatcircles.media.mit.edu) can provide a good space for interaction in an otherwise scary and isolating space like a hospital or clinic.
I also want so way to know the status of my bill. Assuming you are speaking of a US health care site since only here do we have support for such a multitude of models of what an MD's office is. But one of the problems is the variety of financial models for paying for health care. My monthly bill never tells me where in the chain the fee is. Did the bill get submitted to the insurance company? Did it go to the right insurance company? Am I covered for this visit under the 80/20 copay or the 60/40 one? Did anything get disallowed? (I'm assuming they would have told you about this, maybe not.) Has the insurance company given you a final status or just a tenative one? And how do these questions apply to the mysterious "previous balance". I find myself waiting for months to pay medical bills because I can't figure out what I owe for and what will eventually get covered by the insurance company. And this doesn't even begin to cover the times I have to start sending letters to the insurance company to get them to explain why they disallowed something that I thought they should have payed for.
So, let's have good security, but I do want to have access to my financial records - and in sufficient detail that it will back me up when dealing with the real blood sucking ticks of the US medical business, the insurance companies.
4 TIMES more expensive than a doctor? What are you a DRUG DEALER? :-)
When I enter the webpage, I want a modal dialog window to popup and say
"If this is a life threatening emergency, get off the web and dial 911"
:-)
At the medical center where i work in IT, there is an attached doctors clinic that we support. There are computers in every exam room. They run programs from a terminal server, and can record all kinds of stuff. They can even write up a subscription, and then walk over to the nearest laser printer and sign it. It's all really cool.
I think that some of the others are right though. The patients don't need access to all of this. Here, in our clinic, the doctors all have access to something called "image manager" basically, all records from the entire medical center are scanned into the system, and the doctors can look at them from just about anywhere. They can be hooked up with RAS, and can look at their patients' records from home.
Believe me, the security is rather good, and several layers deep. They even have to use a specific code number based on a predetermined algorithm. The security provider generates a number every minute, and a keychain that the doctor has generates the same number based on the same algorithm. the two have to match or else the doc doesnt get in. Sure the keychain could get stolen, but the doc's usually attach it to their lexus/mercedes/beamer keys.
Also They just want to pad their fees in order to squeeze yet more $$$ out of the insurance industry
this isn't exactly true. The computers that are in the exam rooms are only p75's it works just fine for the purposes that we use them for. They are just leftovers from when the rest of the hospital upgrades. Eventually they will all be up to 133mhz which will also be just fine for the terminal server junk that they do.
----------------------
Opportunities multiply as they are seized. --Sun-Tzu
Auditing.
The system should keep a full audit of all system activity. It may come in very useful sometime later.....
. . . but paper can still be read without power during a blackout after a natural disaster (cough, earthquake) or when that ph@t 802.11 isn't working in the ER.
I am not at all comfortable with the idea that records my life may depend upon would be available only from a network if I end up in a hospital.
http://members.aol.com/medinformaticsmd/
Maybe the clinic already has an informatician on board, or has a grasp of best practices. Or at least, someone involved who has heard of informatics :-)
But no matter how jaded you are, I think you can be inspired by these accounts of spectacular failure:t m
http://members.aol.com/medinformaticsmd/failure.h
...Organizations which involved or approached computing in exactly the *wrong* way.
--
keete
Because people are getting the impression there are nothing but trolls here.
The answer to his question is this: Security. Email and web are the two most common things. You can cut costs on the dedicated T1, as long as you can guarantee security, for your email and web transmissions. Email is more important, but it would be nice to have a webpage with links to preventative medicine and perhaps bulletin boards for people to talk about the emotional problems caused by their illnesses.
If you want your waiting room to have some cheap terminals, fine. That would eliminate much of the bad feeling many have about hospitals and visits.
Don't forget to have some infrastructure for yourself. For example, you might want to be able to call up your patients' email conversations at will.
--Electronic prescriptions (avoid errors from poor physician handwriting. Don't laugh, it happens.)
--Databases to check for drug interactions
--Databases to assist with differential diagnoses (what possible ailments correspond to these symptoms)
--Availability of medical records and lab results at multiple offices (what happens when patient A is typically seen at location X and comes instead to location Y)
--Maintain a practice web site which is a medical portal for current issues (example: pediatricians should have a link to this site).
And come on /.ers, the level of venom in some of these replies isn't necessary. How many of you put your lives on hold to work 36-hour shifts at slave wages for 8 years ... oh, uh, never mind. :-)
You're right that it would be nice for the patient, but it's actually not a minor issue. Pharmacists do make mistakes from misreading prescriptions. Also a device creating a digital prescription can automatically check for patient allergies and interactions with other drugs the patient is taking. It's hard for doctors to stay up-to-date on those interactions.
The thing I'd be most concerned about if I were to go to your clinic is on-line security.
If my medical files are accessible by me on-line, they're going to be accessible to crackers as well unless you do a *lot* of work on security.
I suggest you hire a decent computer security firm - don't just use regular computer consultants, because they generally don't have a clue about on-line security.
You need to build this into your systems from the ground up if you're going to do it right.
All opinions expressed herein are not my own; I haven't had free will since last year when aliens ate my brain.
Google search for HIPPA.
I used to be an enterprise level network engineer/admin for a very large HMO/Clinics corporation. When we started to design a new clinic, we looked into most of the tech you ask about. Guess what. HIPPA raised it's ugly disgusting head and we couldn't do 90% of what we wanted to. Frankly, I'm getting extremely sick of having the Fed's tell me what I can and cannot do. Our (US) government is becoming overbearing to the point of silliness.Dive Gear
--- Think of it as evolution in action ---
Your French is a bit off. I think you mean:
n'est pas?
Here are a couple of things to add to your dream system:
1. The ability for the patient to upload lab results from other doctors. People with chronic conditions DO change doctors and having a baseline is vital in disease management.
2. The ability to download those same lab results so the patient can keep a personal file for use by another doctor (or themselves) in the future.
3. A "WARNING, DON'T PRESCRIBE ME THESE MEDS" section. My wife has been prescribed more meds that conflict with others or worse, been prescribed meds that should NOT be prescribed to anybody with her condition than you can shake a stick at. C'mon guys! You ain't perfect, stop acting like MDeity's and let's work together to minimize medication problems.
4. A description (maybe a picture?) of what each med should look like along with the script. This would help avoid the wrong meds being dispensed by the pharmacy.
5. Automatic sending of prescriptions to the pharmacy. (Hey, some docs already do this electronically.)
6. Putting your copy of the PDR CD-ROM online and available to your patients.
7. Putting your copy of the Drug Interaction Guide online, yada yada.
8. A place for the patient to make notations on each medication prescribed (call this an annotated medication history). Currently my wife does this manually on the computer, but it makes a lot more sense to make this available to the doctor NOW, rather than having to wave it under their nose during the 2 minutes they have to decide on which med to try next.
9. A place for speciality patients (high blood pressure, pregnancies) to chart information such as daily BP's or weight gain, etc.)
10. TIGHT, TIGHT! TIGHT!!! SECURITY
11. The ability to change or delete info if the patient becomes uncomfortable with the service. Such as if your computer got hacked, I'd bail out until you got your act together.
12. FYI, the more serious the patient is about controlling chronic conditions that more knowledgeable and more motivated they are to use your services and the less likely they are to change doctors. Remember, the less patient turnover you have, the more money you make and the better the outcome is for the patient.
13. Access to the physician portions of all those good web sites like Web MD as well as links to sites looking for volunteers for new meds.
14. A clear and cogent explanation of each test, what is being accomplished by it, what the results mean, etc. A patient with diverticulitis would love to know what a hematocrit is, why you keep taking it and what it means when the bottom drops out of the numbers.
I want phone based WAP access to my appointment schedule, my dosage of my medications, and other "trivial" information. I also want this for my two kids, who see the doctor and get medicine far more often than I do.
AND I want my phone to tell me when my doctor will REALLY see me, based on his case load for the day. Not the appointment time an hour before hand that I have to show up and check in, or risk having to pay anyway.
Vulgrin
I sig, therefore I am.
According to the analysis (see URL below), "the Health Insurance Portability & Accountability Act of 1996 (HIPAA), impose a massive and complex burden on providers, health plans, clearinghouses and their business associates." These US Federal regulations are mandatory. Key items from the regulation include:
-- The privacy regulations now extend to all individually identifiable health information in the hands of covered entities, regardless of whether the information is or has been in electronic form. In contrast to the proposed rule, which only covered information that had at some point existed in electronic form, this now includes purely paper records and oral communications.
-- Providers will need to obtain a patient's consent to the disclosure or use of the patient's health information for ordinary activities, such as treatment, payment and the entity's own operations.
-- Enforcement of the privacy regulations has been delegated to the DHHS (Dept. of Health and Human Services) Office of Civil Rights. The regulations do not provide for a private right of action permitting patients to sue for violations, but do contain both civil and criminal penalties for violation, including fines and imprisonment (e.g., a fine of up to US$250,000 and imprisonment for up to 10 years, for knowingly disclosing or obtaining protected health information if done for commercial or personal gain or for malicious harm).
For more information see: http://www.dwt.com/practc/hc_ecom/hc_ecom.htm
All of this stuff is fine and dandy, and could be very helpful in the long run, however, what if this system were to be comprimised? Most hospital data isn't extrememly sensitive, but some of it could easily be confidential. Also, if we keep with the trend of putting every conceivable thing on the internet, more sensitive data could easily get out. The US armed forces are fighting a constant battle against crackers etc., and just barely staying ahead of the latest hax0ring utilities...
Also, take into consideration that the incorporation of these standards into vendors' products is excruciatingly slow at best. Several years ago, vendors had the idea that we can take care of all of your healthcare information systems needs -- "Our system does it all!". Well, they soon learned that healthcare information systems were extremely complex and they couldn't manage/keep resources to maintain/produce such huge systems and still make a profit. Enter the age of the "Best of Breed" system. "Our system just does these few things, but it does 'em really well! You just need to buy/build an interface to get it talking to your other systems!" Many of us that work in healthcare IT cringe whenever someone mentions an interface. The results you get from stringing together lots of interfaces can often be like playing the telephone game - send a piece of information from one system through one or more interfaces, to another system and hope like hell it makes sense on the other end.
You guys are on the right track when you talk about security. I worked at one hospital that was in the "Top 10" hospitals in US News and World Report a couple of years ago and some of the stuff I saw floating across the network was scary. We had some clinical systems that sent their userid/pw across as plain text. Packets floating across the network often contained patients names, clinic notes, diagnoses, lab test results, etc., all in PLAIN TEXT! It was amazing how much information I could obtain by using an evaluation copy of a packet analyzer on an unsecured network port at this institution.
One scary trend I've noticed lately is all of the people/vendors that want to download patient information to PDA's without having adequate security on the PDA. I'm just waiting for some doc to lose his Palm and have some kind soul find it and turn it over to the local media. :)
There are lots of other issues that futher complicate the whole healthcare information system issue such as institutional politics, workflow/usability issues, etc., but I don't have time to get into them right now.
Personally, it sounds to me like these guys need a serious whack with a clue-by-4... that or they need to get out and do a bit more research on the subject at hand..
Now, some of what you've mentioned is quite interesting and has good potential benefits. Like, chat rooms for asking questions. It would probably save people trips to the doctor if they could just ask their question without going in. Stuff along the lines of, do I need to worry about X, or my kid has x,y,z symptoms should I take them to the doctor. Or support groups for people with various syndromes. Or a database of medications and their interreactions. But a lot of this could be handled by having a nurse on staff to answer a telephone.
I think, though, that you should consider what people's motivation is for going to the doctor. They want you to make them healthy (or keep them that way), to treat them like people, to see them on schedule (as close to as possible), to listen to their concerns. Look at what you can do to improve these areas of doctor-patient relations, using technology, carefully.
"This message is composed of 100% recycled electrons."
I am a physician who is setting up a new adult medicine clinic with several other physicians.
If 'adult' medicine is your game, then perhaps computers with internet connections in the waiting room could be your solution, since we all know that 9/10 of search results for anything will lead to links to sites like this!
I would suggest a "rolling pin" for each occurance. That is, a pin assigned each time you visit your doctor for that specific incident. That way, while someone may gain access to a specific incident, they do not have access to the entire case history. Only someone with a complete listing of their pin numbers would have that access. Also.. doctors are very busy. I don't think real time chat is realistic, but if you can pull it off, it would be nice to chat with my doctor from home, have him issue me a perscription for my flu or whatever online, and run to the store to pick it up, or have it delivered.
-=+=-=+=-=+=-=+=-
following my instincts not a trend...
Ok, it's time to delurk for a while. It's not often that the Slashdot crowd proves that their usually at least minimally knowledgable selves have no clue about something.
Firstly, I am a physian. I still hold a valid license, full rights to prescribe and perform surgery and all that. I have taken a step into the private sector and now work as a technologist.
Most GPs, which are the docs that most geeks see regularly, don't make jack when you consider that they have 4 years of undergraduate education, 4 years (minimum) of medical school, and 3 years (minimum) of internship and residency. Add to this that private practice docks have all the debts and liabilities associated with running a business and are paying off six figure student loans that thanks to the first bush administration have been running up interest those last years of training.
General practice/family practice physicians make on average $130k/year which sounds like a lot except that is not a salary. Docs are nearly always self-employed legally due to requirements that they maintain their independent status. Combine this with the fact that normal benefits still have to come out like health insurance and retirement planning and the income is markedly less. I know a number of family practice docs who start their taxable income well under-six figures.
Whither the Lexus? There is a physican mystique that docs, right or wrong maintain. Since there is a definite 'boys club' for hospital priveleges the air of success and professionalism is a maintained facade. They buy expensive cars even if they can't really afford it so they look successful enough not to raise eyebrows in the doctors' parking lot. That combined with the fact that many patients would be entirely non-plussed to see their physician driving around in a '77 pinto with a brown hood and a blue door tends to push toward trendier rides.
Doctors don't know jack about technology. It's true. I labored unsuccessfully throughout medical school to get a small software venture off the ground. You can't really sell this stuff into a market that doesn't understand. That combined with the lack of money available to fund development of really good back end office apps means that only a couple of vendors exist and frankly, they suck.
Really good medical software would automate charting in a way that's intuitive to physicians. The stuff that's out there requires that the physician learn new techniques. This is no good at all. I wouldn't even build a clinic with much more than a billing back end right now because the charting software sucks so bad. On the other hand, there are paper based charting forms that are built around the way docs were taught to think that work great. Not a retrievable as electronic, but pretty darned good for a start.
I'm not a lawyer, but email and IM of patient data is a minefield under the new privacy guidelines that frankly I haven't been able to figure out yet. That combined with the liability issues of giving out advice without examining the patient makes these technologies a total disaster.
In short, I'd get a solid billing system and wire the office but not install machines everywhere. I would likely do wireless networking to a PDA for writing presciptions just for legibilities sake. I would not do email or IM for patient care, period, let somebody else set the legal precidents.
Dr. Warren Magnus
Of services Available. And Up front pricing. -I mean Mechanics offer them, what's the difference (Wetware vs. Metalware, but its still repair services and tech support right?)
Fish
As a tech working for a good sized hospital/clinic, that, in the past 3 years, has made leaps and bounds in the technology arena, I can tell you that if you do this right, your patients, and medical staff will most definitely benefit. While we don't yet allow the patient to view his/her medical record online, we do have a good majority of that patients record available to the medical staff, via our Intranet. This past year we have tested workstations in the exam room, and the results were outstanding. Both the medical staff, and the patients were very impressed. So impressed that the company is now in the process of putting workstations in every exam room (well over 500 in the local facility, and a good number in our 40 regional clinics). At least some part, of almost all of our medical systems are computerized, so we import data from those systems to our data warehouse. It is very comforting for a patient that has already seen 2 specialists that day, to be sitting in the exam room of their 3rd appointment, with yet another MD, and have the doctor walk in and instantly have access to the labs, EKG, prescribed meds......etc, that the 2 previous doctors ordered/prescribed just an hour before. This had previously been next to impossible, because of the chunkiness of the paper method. Since we are also a hospital, the benefits are even greater. A for instance: since we are the biggest health care facility in the area, we see a good number of patients. If one of those patients has a serious episode, and gets rushed to the ER, those ER docs can instantly see a good portion of the patients prior medical history, which in that situation, can make a huge difference. There are numerous other benefits to both doctor and patient, and we realize more of them very day. I'm excited to hear that more and more institutions are doing this. Having the experiences that I have had in the past few years, I can offer a couple pieces of advice: #1) Be far sighted - Have a vision. Know what you want this system to do, and how far you want to take it. That leads into my next piece of advice. #2) Chose your software carefully - We developed a good portion of what we are using today. We did so because there were no products (at least a that time), that were both mature, and did what we needed them to do. Many of the companies offering software for the medical industry just plain suck. You'll find that a good portion of them are using antiquated software (especially on the backend), support from these companies is terrifying, and a good portion of staff time is consumed by repeatedly fixing crappy software. #3) Security - Huge. Hire a specialist, then after he/she is done, hire another......... It's not a one time affair! It should be a constant concern, and needs to be treated with the utmost respect. I consider you to be quite lucky. You'll be building from the ground up. We had to build around many of the medical systems that we already owned (interfaces galore). Good luck on your journey.
Probably not, but I would sure like it. just because it wouldn't benefit everybody doesn't mean it's not a good idea. Just as long as it isn't mandatory.
"Prefiero morir de pie que vivir siempre arrodillado!"
How bout some high tech cooking. I had a long stay in the hospital and the breakfast was deluxe but the dinner they served was like generic hungry man grade. Maybe you could hire iron chef?
Speech recognition for your staff (who will have the time to train such a system) will help you translate your speech into text for the growing elderly/hard-of-hearing/deaf community. Speech recognition can be coupled with translation software to assist when you are dealing with patients who don't speak your language, or with Telemedecine where the remote end doesn't neccessarily speak your language.
I would contact Columbia University Medical Center. Six years ago Columbia established a interdepartmental research lab to investigate the use of computers in helping treat patients. I was a Doctoral Candidate in Electrical Engineering at the time and was working with the Department of Radiology to help them use computers and high-speed networks to work on telemedicine and remote diagnoses. The hospital was interested in setting up networks in Doctor's offices and facilitating electronic consultation between the experts at the hospital and the family physican working with the patient.
The Economics of Website Security
On the other hand, one -can- reasonably ask:
1. How much money is actually collected from food makers for Kosher certification services?
2. Does the non-Jewish consumer get sufficient value from the contributions - made by individual Jews and/or Jewish organisations to society (e.g. its culture, medicine, law, science, etc.) - to make paying a little bit more per food item a neglible expense?
It should be possible to get a factual answer to the -first- question, e.g. from food makers, possibly from their annual reports (i.e. if your estimate of the total cost is at all accurate).
I can only answer the -second- question for myself: Definitely, YES! (You milage will vary and obviously has... :-)
My question to you is: Since much -more- $ is spent (invested?) by those same food makers to market, advertise, promote & colourfully label their products - much of this likely to chew up trees & other natural resources to print some of it on... why aren't you "barking" about -that- "extra cost" - as you might view it?
Anyway, I feel that you're harboring hate, and I - for one - don't think you'll win any support from that attribute.
"The only limitations are the ones you take with you" - CSC Sys Sci Div
I'd say: Hate is a limitation... leave it behind.
But you can decide for yourself... ;-)
You absolutely must be able to converse with patients using PGP encrypted e-mail.
Hi Bolus,
I'm also a physician facing the same issues and questions that you do. Overall, the big reason to make use of new technologies is to be more efficient, and allow you to spend more of your time seeing your patients. Obviously, you don't want something that's going to take time away from your patients (i.e. paperwork, paperwork, paperwork, etc). Why have doctors been resistant to adopting electronic charting software? They say, "It takes more time and effort than handwriting a typical SOAP note!" Allow me to give some opinions and suggestions:
Hope that helps... :)
Just as most doctors offices refuse to fax charts, I doubt any practice or hospital will allow online viewing of charts. They refuse to fax charts because they cannot be sure who is waiting at the receiving end of the fax machine, even if they verified the number was correct. As easy as it is to steal someone's social security number, name and address, it would be all to easy to get someone else's chart online. No doctor wants that kind of lawsuit, and people don't want to see their charts online bad enough to offset the costs. If you want a copy of your chart, have it over-nighted or pick it up in person. If someone intercepts it that way, it is either the patient or shipping company's liability then, not to doctor's.
Yes, going paperless does have its advantages and doesn't seem like a bad idea, in the long run it might even save money. But there is very limited reason why these computers need to be connected to the Internet.
If an office is utilizing a T1 as a patient I'd be more than scared to use these doctors as there's no legitimate reason to be using that much bandwidth. The insurance companies that are online use simple html forms and unless you have upwards of 20 doctors it shouldn't need more than a simple modem or dsl line.
The scariest part of the whole Internet thing is that you will be making things available for people to see on it! People do not place enough value on securing their information to allow them to have their medical records online. I can easily see a coworker of someone knowing that a person's password is their child's first name and the number 1 and viewing their coworker's ENTIRE medical history! In addition, web technologies are still not foolproof from hackers either; I wouldn't want my medical records online yet.
Anyways, I definitely would want to see a wireless access point put in so I can take my laptop and do work while I'm waiting for a doctor.
Most doctors are way too busy to have time for instant messaging. Same thing for video conferencing. It would be nice to be able to set up a new appointment online instead of sitting on hold on the phone for 30 minutes. Also, you'll need to have preparations for when your systems go down.
A whole backup system for cases like in California where power may sometimes go out. i dont want to be at the hospital and have the whole building loose electricity and my doctor not know how to treat me. I think it is still a good idea to keep paper until you guys have a ups backup system that can power the whole building for a day along with generators.
But I don't want such a annoying doctor as in startrek voyager!
There's a project going on here (in Germany) to give patients Internet access for several purposes. One is simply to keep contact with friends and relatives. But there are also projects to have live video streamings from classrooms, so kids don't miss so much time in school. It's especially targeted on kids with diseases like cancer that keeps them in hospital for quite a while.
My advice to you Bolus is to abandon your system development effort right now -- save yourself some money; you clearly don't know what you want to build so don't start building.
It's pretty evident that they already know some of the things they want to make available to patients. Why ask for geek opinions? Given the numbers of us in the /. community, certainly a certain percentage would be patients (you would appear to be among those who never go to the doctor and therefore clueless as to what those in the other group might want). Unlike the patient population at large, those of us here might not only know what we'd like to see implemented, but have the sense to know what is possible via available technology and what is not.
As to why the docs don't ask thier patients, this sounds like a new practice that they are building and likely don't have an established patient base to poll yet.
--
As a matter of fact, I am a lawyer. But I play an actor on TV.
It's relatively minor, but I'd really appreciate it if my drug prescription would be printed out from a computer. Often times, I walk out of my doctor with a note that appears to be written in some dead language. I don't know how pharmacists can read them (I guess that's why they always call the clinic knowadays).
I think a bulletin board of questions and answer or a FAQ, pricing schemes, and a way you could track your history. Another big thing would be online paying, where you could setup your payments online without having to make a trip in or wait for snail mail to arive. --We Put the IT in shIT! --
Putting the IT in Sh**
Last thing I want is my surgeon cybersexing some truck driver in Massachusetts pretending to be an 18-year old nymph called Valerie, whilst operating...
Ouch!
The Master Of Muppets,
CAPTAIN: TAKE OFF EVERY "SIG"!!
Most doctors make less than high tech workers. They don't get to charge whatever they want. The insurance companies are the only ones getting rich here...
How things REALLY work is that insurance companies set the rates that they are willing to pay for different services. They also limit a doctors ability to prescribe certain drugs, offer certain kinds of treatments, etc. Some insurance companies that do HMO plans tell the doctors that they will pay them X dollars for every patient whether or not the patients use services - so you make money on the healthy patients, and lose out the ass on the sick ones and in the end, you hope you did a little better than breaking even. If you are a doctor and want any patients, you WILL bow down to the insurance compnaies and accept what they offer. Here in the valley, Sutter (which manages dozens of clinics including Palo Alto Medical foundation) won't accept Blue Cross anymore because they were losing money for every patient since BC was only willing to pay 1950's rates... This REALLY sucks if your employer only offers Blue Cross and your doctor is in Sutter...
Now if you want to make money in the medical field, go into cosmetic surgery or something where the insurance companies don't have any control.
Instead, you may want a web form on a secure https web server where patients sign in and communicate over a private webmail type system.
In general, security security security. That should be the first thing you think about. VPN's for doctors at home, SecureID tokens, etc. Don't leave terminals logged in that patients can screw with. Disable booting from floppy / CD in BIOS and enable BIOS passwords (better yet, use diskless or hard disk only workstations.) Use screensaver passwords, and short timeouts. Don't allow ANY non-authorized software to be installed. Isolate your web systems from internal systems and make sure passwords are not shared between the two. Consult a security expert from a reputable firm (I think Price Waterhouse Coopers does this...)
Drill into ALL employees how important security is - many people can get frustrated when you have lots of security, but with proper training they may understand it and accept it.
Kudos to walt-sjc!!! Don't mean to get off the subject of the parent post, but I feel compelled to educate everyone on our medical reimbursement system and how doctors operate. I am a physcian and am, unfortunately, very familiar with medical billing. walt-sjc was absolutely correct. Physician reimbursement is based on fee schedules (lists of prices for services) that are determined by the Health Care Finace Authority (HCFA) - a government agency in charge of lowering the cost of MEDICARE health care. What all insurance companies have done is to also base their payments on this fee schedule. MEDICAID for example pays approximately 50% of medicare. Along with this, HCFA also requires very specific documentation points to qualify for different levels of payment. If a physician is found to bill in error - regardless of intent - that physician can be fined $10,000 per occurance and possibly face jail time. Where electronic medical records (EMR) comes into play is this last portion. The EMR will monitor your documentation for a particular service and then pick the billing level for you....guaranteeing that you are in compliance. The other benfits include reducing overhead and speeding up insurance payments. So you see, adding an electronic medical records system only adds money to the physicians pocket because of decreased overhead and heaven forbid, an audit that would result in several fines.
-A
Seriously, having lived in two countries with free/80% subsidised health for all, this question really does seem to be an echo of that Python sketch
There needs to several levels of improvement in the way docters and the medical insurance business account and pay for services. Specifically the HMO will not cover certain expences without the doctor "checking" off certain diagnostics were done. It is a contract managment problem, a doctor-patient problem, government - hmo problem and many others. Contracts -- especially government regulations change this landscape daily. :-)
One problem with any solution is to push doctors into a cookie-cutter approach to helping their patients.
If you have a doctor doing cookie-cutter medicine then having an AI system take over is the next step.
Have two networks: one for net browsing and another for in-house records just to be safe PLEASE!!!!!
So, out of 1,000,000 clinical trials, only one patient didn't recover as predicted by such and such's neural net(they're *all* that accurate, of course). Was this a million cases of a mildly scraped knee? Did that one patient some how get his scrap infected with flesh eating bacteria? Flesh eating bacteria throws neural nets off every time, I bet. My point is, there is no possible way for an 'artifical neural net' to be that accurate with *anything* as complicated as medical diagnosis. Last I knew neural nets weren't down to an exact science. For an exisiting artificial neural net to be that accurate, the case would have to be something as simple as: 'Is this color black, red, or green?'
-
Having said that, here's my answer to your question:
NOTHING.
I want the doc's to have STABLE equipment, stuff I can rely on.
I know the feeling of not being able to move an inch way too good.
What you want as a patient is TRUST and CONFIDENCE.
You want to KNOW that the monitor measuring your heart-rate doesn't fail.
You are worried about air-bubbles in infusions.
You want nurses and docs to have TIME !!
Put a TV and a VCR in each patient's room, have some videos and headphones (!!!) ready.
Let a nurse come along every 45 minutes.
That's WHAT I REALLY WANT, HONESTLY.
And believe me, I really know what I'm talking about here.
Good luck,
george./
As a boarded internist, intensivist, and pulmonologist, let me suggest a few things that are particularly useful in a networked clinic. 1) Security: Of course, access to the patient information should be restricted to the local network. Access from the Internet should be completely restricted except perhaps for SMTP. Furthermore, the user identity of all read, print, and write requests to the chart should be logged. Of course, any database is only as good as its last backup. 2) Database: Presumably, a RDBMS will be used to manage the information in the patients' charts. The database should of course meet all the ACID test requirements. See http://openacs.org/philosophy/why-not-mysql.html 3) Medication: While many pharmacies provide drug-drug interaction expert systems, many patients need to go to various pharmacies due to issues of reimbursement. For these patients, it is imperative and relatively simple to implement a meds list and cross check it with a drug-drug interaction table. 4) Patient Education: In these days of managed care and shortened facetime with patients, basic patient education is often delegated to a few minutes with the nurse, physician assistant, or the clinic assistant, if it is addressed at all. A list of printable materials and online movies can provide important instruction such as insulin administration, use of a metered dose inhaler or peak flow meter, or other medical devices. While these will never supplant F2F education, it allows the limited time with the patient to be used for issues specific to the patient. 5) Dictations: While dictating to the computer through a voice recognition system would be nice, it is much more important to keep track of procedure notes and consultations. These items already being transcribed to a digital system could be easily entered into the database from CD-ROM or, if the transcription service is unable to provide digital files, through OCR. 6) Level of Care/Billing: With Medicare recently increasing its attention to acuity/level of care, it is important to provide clear documentation to justify billing codes. Underbilling is being penalized just as aggressively as overbilling. Being able to document time spent with the patient, reviewing medications and notes, entering progress notes, and dispensing education materials is critical in justifying higher levels of care. Conversely, the system can be setup to prevent inadvertent underbilling for visits that require more than usual time with the chart. 7) Bells and whistles: While many bitheads may suggest that things like instant messaging, discussion forums and online appointment scheduling, these introduce security/reliability issues and furthermore are superfluous. Although email/SMS/pager reminders of appointments might be useful for the chronically forgetful patient, they are probably for the most part unnecessary, if not outright intrusive. Several Usenet groups and WWW forums provide medical support groups with a larger audience than could be provided by the local MD. Electronic scheduling of appointments is not quite the same as purchasing airplane tickets. Especially in a busy practice where appointment slots (both new patient and follow-up) are at a premium, it is critically important to triage appointment slots to those that need to be seen immediately rather than later. While not quite specifically in the sphere of outpatient clinic practice, the integration of a PDA in the inpatient setting would be fairly useful for purposes of billing for inpatient services and integrating the inpatient course into the outpatient chart. In summary, a well-designed high tech medical clinic provides a secure and reliable way to administer and document patient care and education.
How about a message board system running slashcode?
Patients could ask Doctors for medical advice, and Doctors could compete for Karma. Bad medical advice would be moderated " -1 Kevorkian " and Funny medical advice could be
Well, maybe I'll have to work on this one some more.
But think about who would be most likely to use it. Your friendly neighborhood hypochondriac used to have to buy a book to find out what was wrong; then came the www and easy-access medical-advice sites; now you come along and give him/her instant all-day access to answers from a real live doctor! As much as I'd like to be able to chat with a real doctor when I'm too nauseous to talk on the phone, I'd hate to have to fight to be heard through a crowd of these people and you would never get any work done. Maybe a forum on your site would be better.
Dude, without knowing your location, why use a T1? For a fraction of the price, you can probably get SDSL. Hell, in my neighborhood it's cheaper to get multiple SDSL drops than a single T1 line. And the bandwidth.... OH MY GOD, DO I MAKE YOU RANDY, BABY!!!
pi=sigma{n:0-infinity}[(1/16)^n][(4/(8n+1))-(2/(8n +4))-(1/ (8n+5))-(1/(8n+6))]
You can get the latest medical, drug, and procedure research available over the internet. Almost all the medical journals are available in a full-text searchable database.
If you are going for it you might as well include the kitchen sink!
My relationship with Ovid is one as a former employee. I get no kick back for this.
"People need reset buttons"
I'm the type of person who likes a lot of information about anything thats wrong with me.
:> ).
I think people don't neccesarily need to see every chart or every x-ray. But a prognosis with information tailored to individual patients in a portal type of web interface would likely be very bennifical to everyone. WebMD looks like they have everything I could dream of, but it would be alot nicer to get this information from my doctors office rather then a faceless company.
The internet is still about information collection and dessimation right now. People expect to be able to find answers to almost any question they have.
When I go to the doctor to see what's wrong with my body, I use that as a starting point to research out for myself excatly what I have, and what course I need to take to get better. Of course, the doctors oppionion allways rates higher in my mind then anything I find on the web, but having the information and being able to talk on the same level with my doctor on a follow up visit is important and usually very bennificial.
I agree with lots of other people here, secuirty would be my biggest worry. But people do there banking online all the time. As long as you were at least as secure as my banking internet system, I'd feel safe with it. For sure this system should be entirely opt-in / opt-out (and open source
rejected (19) accepted (0)
Is there a psychological term related to getting your stories rejected on slashdot?
I can't help but point out the obvious fact that you really shouldn't be asking us. You should be talking to your patients, finding out how many of them use the internet regularly and what they feel comfortable with.
I, for instance, would drop a doctor if he started offering access to my medical record over the internet. We talk about how important security is, but large sites are compromised all of the time.
This subject deserves a far less cavalier attitude and far more research than (it sounds like) you have invested so far.
The Doctors having the PDR springboard on their Handspring Visors.
The below available via a CD that I can get from the office:
My records available in PDF format
My X rays avaiable in PDF format as well
On line scheduling, not so much for me, but for the receptionist who can then tell at a glance when the Doctor is free, saving him/her time and reducing my time on hold.
Bill tracking on line, so that I can sort out what has been coverd by my plan and what I can write off at the end of the year
http://radio.weblogs.com/0103443/
Privacy should be your prime concern with this type of service. Email is one of the least private ways to go. You may want to check out a site like http://www.esalveo.com/ . My doctor is currently using this service. You have a login and password, and all messages between you and your doctor are kept private.
i believe that the T1 would be best put to use as a source of high quality streaming pr0n, to make semen collection for fertility analysis all the more efficient.
oh yeah...and some of those plastic waterproof keyboard overlays.
Data integrity and security needs to be first and foremost where lives are at stake.
The human factor is still paramount in medicine. Perhaps the most vexing problem many patients face is the difficulty of getting ahold of a doctor when questions or concerns arise. E-mail could help fix this, but only if the doctors set aside a certain period each day when patients can rely on him or her to respond to e-mail. This lets a doctor respond to concerns individually, in an efficient manner. Of course, this assumes the doctor is good at communicating clearly with the written word. In my experience, many are not; they're not professional writers, of course. It would be nice if technology can fix annoying and dangerous aspects of our health care system, but right now, the biggest problems are human, and they don't go away no matter how much technology you throw at them. Don't forget that when designing your clinic.
Oh yeah - and I'll echo what the others have said: Security, security, security! Password-protection won't cut it. With medical info, you can't afford to screw this up even once, ever, so hire a real expert and Take the time to educate yourself about the issues.
I stole this sig from someone cleverer than me.
ChelleyBean
I recently spoke with a pediatric clininc that was looking to move to a more modern appointment and billing system. They are using an antiquated DOS and NetWare based system that has grown insufficient for their needs. Unfortunately, when they showed me the top two offerings, they both were horrible. One that they investigated involved the server being somewhere in Texas, while they (at their clinic) used Citrix WinFrame to view applications on the server, with 6 stations running concurrently over SDSL!
;-). But all the solutions providers seem to be pushing old technology that they may have dressed up as 'client server' from something that isn't (i.e. the Citrix WinFrame attempts), or have just put a pretty face on some big iron server (i.e. using TN3270 as a front-end).
In talking with them, it seemed that there were really no flexible, modern solutions for what they needed -- a multi-physician appointment scheduling and billing system. It sounds like it should be a fairly straightforward thing to implement -- a decent database backend (say, PostgreSQL) along with a nice GNOME/Gtk front-end (of course, I say this never having written such a system
I'm glad to hear about attempts such as the one described to create a modern medical office -- it will be interesting to see what problems they run into and how they are solved. Hopefully something like this will be a wakeup call to solutions providers.
Incidentally, from a free software perspective, I wonder if a free software application could be accepted in this community. Small clinics could use the software as-is, and large clinics could contract the developer for customization. But again, would such a solution be looked down on because it's free and open sourced, something not often (ever?) heard in the medical community?
A giant tape library, and some generators for when the power goes down.
Sorry, I live in California and am a lil paranoid.
--Dave
Get a life, don't be so rude, "Bottom line is: Pull your self-important..."
The original post specifically asked people what they wanted. So what's wrong with responding with what you want and explaining why??
Unlike YogSothoth, you added nothing to the discussion. We all know what happens now, doesn't mean we should give up trying to find a better way!
This is a little of topic. But look at flat panel displays. They may be more expensive the crt's but the life is much longer. Also be ready for sticker shock when looking at the. You will be looking at about 10 thousand for a video card monitor combo to start. Also be aware reporting systems are now starting to be DICOM compliant.
By definition, a government has no conscience. Sometimes it has a policy, but nothing more. - Albert Camus
Just a thought, but what about patients who can't use keyboards, or areuncomfortable with such technologies. Would having full net access to your records really be helpful to an 83 year old grandma that only speaks Spanish.
I would recommend having remote access to your patient records with a PDA. That way, when you are anywhere but the office and the Emergency Department of a local hospital calls you, and you know they will at bad times, you can pull up the patient info no matter where you are. I know I would love to have access to some things like that on the ambulance...hmm, come to think of it, I'm in charge of our computer system, I better get to work hehehe.
of the risks involved, AND not to give out passwords or other security information.
mod this up, even if it is a coward
LEXUS stands for Luxury EXport to the US so the plural would still be LEXUS I guess, Luxury EXports to the US...
Maybe the AMA should be asking Slashdot for suggestions, doctors shouldn't be making technology decisions.
And the kicker is, if you're late, they're more than happy to charge you a fee for wasting their time.
But at the same time, having worked for several medical clinics, I understand why providers are so often behind schedule. A lot of them, especially specialists, have on-call obligations with local emergency rooms that have unpredictable time requirements. Plus, you can't always make a good diagnosis on a patient in the alloted timeslot. If the guy in front of you has complications, they're not just going to hand him some aspirin and say "Time's up!"--you wouldn't want them to do that if it was you. Add to these items that fact that average reimbursement has been going down in proportion to expense the last few years, which puts an immense pressure on providers to try to invoke economies of scale (see as many people as possible in a day), and you have a recipe for a lot of wait time.
Personally, I think the solution would be to change reimbursement practices, although I don't have a good suggestion of how. But as long as they are based on how many people providers can cram into their schedule in a day, you'd better bring a magazine.
No relation to Happy Monkey
This is a really great idea. My wife and I had discussed something similar (she has a dairy allergy, but seems to get mac&cheese at least once every time we're at the hospital).
The problem is, I don't think the people actually preparing the food care enough to do anything about it. They make next-to-nothing, (except the dietician) and so don't care whether they kill you by giving you peanuts or not... it's not like they've ever met you or anything.
Perhaps I overstate the problem, but, truthfully, most people in healthcare (besides the doctors and the higer-up administrators) aren't paid enough to care about your treatment. Thank goodness for those who really do seem to care, and make the healthcare system work, despite it's deficiencies.
And why is it that every doctor believes that he can play systems analyst. Having worked for a major hospital, it's always a laugh when you ask a doctor to explain how they plan on securing their patients medical records. The best answer is that the security is built into the software. "Well, medical manager, (or HBOC, or Cerner) has built in security features.)
Yes, I after reviewing your records, I'm sorry to say it could be fatal. See another doctor quickly.
Just do your patients a favor and keep a critical care sheet printed that includes things like allergies, etc. Don't get me wrong; I am all for the modernization of facilities, and even the moving from a paper office, but there are a few places where technology is reliant on services that may not be there.
Just because you write code, doesn't mean your an engineer. Unless you also drive a train...
...I think it'd be wise to keep paper records as well. What if your entire network comes to a halt? You wouldn't want all of your patients to have to wait for care while some poor sys admin to fix the damn thing. Also, what about those less fortunate individuals who cannot afford to own a computer and have Internet access (granted, you can find net access for free in some places but people not in touch with the Internet won't know that).
How about improved communication between my physician and the ER so they don't amputate the right leg when they should've done the left one?
"Ancillary does not mean you get to rule the world." --U.S. Circuit Judge Harry Edwards, speaking to the FCC's lawyer
i've had my own idea of this for ages. what they need is for each doctor/nurse/etc to have a small palmtop computer with wireless LAN capabilities. this way they can instantly get patients details by simply reading the patient ID off a bracelet or similar, entering it into the palmtop and downloading all their information. it's such a simple idea, and all the technology is around, i don't know why it hasn't already been done.
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Never send a man where you can send a bullet.
In our office we schedule apointments in outlook, inviteing everyone attending. Now when I have a personal apointment I schedule it and invite my home account so it's on both computers. I would love to schedule my followup vist, come home and find a apointment in my inbox, this way I wouldn't forget about it comming up soon.
When I had an operation last fall i had to stay over a couple nights. The hospital had lame ass, super basic cable - I remember settling on a Dukes of Hazzard marathon, blah! After the operation I was in total pain and the only thing that gave me solace was watching TV. I wonder if you could give patients access to high budget cable, movies on demand, even beter - a sony playstation 2 to help the recovery boredom.
Children, remember, there are no stupid questions - only stupid people.
I'm serious. I'm sick of waiting in the waiting room for huge amounts of times when I made an appointment. I bet doctors would get pissed off if they made a booking at a restaurant and had to wait for an hour to get their table. It's just crap that you guys get so much education but yet don't learn time management or planning skills that they teach in 4 year engineering degrees.
Anyway, HIPAA mandates the kind of security we (read: technophiles) think should go into an end-user type of application. It also mandates the generalization of a LOT of the medical informational industry. Right now there are no standard protocols, no standard formats, and expenses are high. HIPAA will lower costs by mandating protocols and standards. It will raise costs by mandating security procedures. However, the security procedures should be more of a fixed-cost, and not variable, like data transmission is currently, and so shouldn't raise prices extraordinarily.
Now, onto the best technology for a doctor's office. I'm a systems integrator for a medical billing software company. We're designed clinics before, around their billing and records needs. What we found, by asking the doctors and patients, is that the only information that needs to be readily available is the patient's medical information, and that's only so that the patient can get in and out in a timely manner.
Security needs to be the foundation of the technology used to setup the system, but the design needs to have the central idea that the patient needs to get in and get out, and wants their costs to be a minimum. Have their records online and accessible on the LAN, but not externally, because the patient doesn't care. The only patients that need access to their records are those involved in litigation, and there are currently procedures in place for that (I used to work for a medical records provider).
So, you want the patient's chart available throughout the LAN. You also want a charting/documentation package available at your fingertips. What a doctor does after he sees you is he diagnoses what you have, and writes that down. Some lady figures out what CPT/ICD codes that corresponds to, and you get billed for that. The doctor needs the ability to find the write code through a text search, preferably touch-pad, and preferably fast, while he's talking to the patient.
The nurses need access to an EMR package where they can touch-pad in the patient's vitals, and save if to their records to be looked at by the doctor.
The billing side of the office needs to have access to those ICD/CPT codes, because that's what's sent to the insurance companies on the health insurance claim form. So you're going to need to have a billing package (shameless plug: http://www.soft-aid.com ) that can interact with your charting/EMR software.
So that's what a doctor should design his clinic around. Everything else is just "bells and whistles".
tachyon@SPAM-ME-NOT.tampabay.rr.com
Having a "wired" office is cute and sweet, but that's not where tech in the office matters, and I think patients know it. I also think a lot of people would look at the froo-froo stuff and wonder if its one of the reasons their health insurance premiums are going up so quickly.
Most people want scheduling that works, and receptionists who can explain why the office is behind schedule. People may not be thrilled, but they're more understanding of delay when told that there was an emergency case at 1 PM that put everyone back half an hour, especially if the late-in-day appointments can be called before they arrive so they can time themselves accordingly. That's not tech. That's humanity and good management and contact skills.
I refuse to let my medical records go online. I've worked in managed care and in medical advocacy. I wouldn't trust most organizations with the security or with the backups required on the systems.
Environmental Protection = Using Marketers as Compost
Please provide all forms that we need to fill out available online. That way, we'd have all the "paperwork" done prior to even stepping into the office. We can then have them verified by our "digital signature." Hopefully this cuts down on the expected time we need to spend in the office.
Linux at home
Was Ist Die Befindlichkeit Des Landes?
Fight censors!
"Not my manner of thinking but the manner of thinking of others has been the source of my unhappiness." - M
I would want all of the above. But if you do it, make sure you use all open source software. Irc would be nice, but if you have normal users for patients, it would be best to have some sort of java applet or html version of the chat... The BB is a great idea. Video conferencing is a nice thought, but is it a good idea?
Fight censors!
"Not my manner of thinking but the manner of thinking of others has been the source of my unhappiness." - M
Be careful to check the HIPPA regulations. They are very strict when it comes to patient comfidentiality. I work at a major medical lab in CA. We have to be careful with encryption and recordkeeping. Remember with HIPPA you not only have to keep the data secure, but you have to know who has had acces to files and when acces was given. Personaly I would love to be able to see my own records.
Rusty Minden Scientia non est potentia, quae prologum potentia solidum est. Knowledge is not power, but the prelude to
First of all you need to plan two networks, a public one and an internal one. The two should only be interconnected through a firewall. The public side is what connects you to the internet and any publicly accessible terminals, say in the waiting room. The private side is everything else. You will need to double up on all your servers to ensure availability and make regular backups which are store securely off-site.
I would suggest using tokens such as smart-cards for identifying patients. Only allow access to confidential data through public networks over https using the card. Patients who want remote access can pay the $30 or so for the reader.
Workstations for the clinic should have readers so the data for a patient can be retrieved quickly and without ambiguity. To ensure that the card is being used by the right person, think about having a photograph in the database so the presenter is tied to the card (important when a person has more than one patient card, such as a carer or parent). Information about drug restrictions due to adverse reactions should be flagged immediately.
None of this is cheap, but it could all be done by mostly taking off-the-shelf s/w and fitting it together.
See my journal, I write things there
Now that we've beaten security to death,
- Allow patients to give pager or cellular email addresses to receive real-time appointment updates. If you (the doc) are running 15 min. behind schedule, your PDA knows this and sends out text messages to any patients who are on the list that day informing them of the delay.
- Speaking of PDA's you can use these to keep up to the minute scheduling info, track appt. changes, write perscriptions, send jobs to the printer (paperless is nice but the patient will still want something in hand when they leave). Save money by not having a hulking desktop PC in every single room.
- FAX software/one-click prescriptions: Set up your prescription system so you can Fax them to the pharmacy with a click/tap. Obviously all the pharmacies in your area aren't going to jump on the tech-wagon with you. Accomodate them and your patients via faxed prescriptions right from your PDA to the customers pharmacy of choice, the same click generates a print copy for your patient.
- Electronic sign-in: When I sign in for an appt., I want the whole office to know I'm sitting there waiting, not just the receptionist with her paper list. This process assigns me an exam room, and flags me in your PDA schedule queing all my data and providing any important updates on symptoms givin at check-in time. You (the Doc) get a full briefing on your PDA on your way down the hall to my room.
- Provide an unobtrusive electronic sign-board in the waiting room that has each doctors name and how far behind their actual appt. schedule they are, like flights at the airport. Then we can all stop bugging the receptionist with "How much longer now?" and can still call work with a revised ETA.
Best wishes.
I don't need to see my med records on-line (I have paper copies, thank you much) and I doubt that you really can pay enough to keep such secured from a determined attacker. I don't need to chat with other people who are sick (if I have a chronic disease, there already ARE chat rooms for such. Video conferencing? With who? *I* don't have a video phone.
Display some adaptability.
Keep it Simple & Secure...
The place (IMHO) where you will get the most mileage is in scheduling appointments.
It would be nice If I could schedule an appointment (and cancel it) online, and if the receptionist could (on an opt in basis) get ahold of me via an instant messenger, or SMS page to reschedule or confirm my appointment.
Records online would be efficient for in the office, but I don't want even the chance that somebody can hack in to your network and get my records, so therefore keep your internal network separate from your internet stuff.
The next step though (and this can be fairly secure) is to be able to communicate with my doctor (not some substitute) via email, so that I can ask non life-threatening questions without having to phone and wait on hold. The doctor can then tell me if I should book an appointment or not.
Even email communications should be secure so that they aren't kept in plain text anywhere for some hacker to find.
my $0.02 worth
One word: Generaization. Even though some - or even most doctors are plutocratic sons-o'-bitchs, it doesn't mean that they all are. Some are really not in it for the money. Some really do have the hacker traits we so dearly guard.
I don't think the $8/hour receptionists would be doing the notes-- I'd imagine the caregiver would be entering the notes unless the caregiver refuses to change over to typing, and only doctors would realistically have that option-- everyone else would be ordered to do so...
I'd imagine there is more cost savings in tight scheduling of the highly paid caregiver's time than there is in hypothetical transcription fees.
Computer notes have some other advantages-- foremost being legibility. It is true that some doctors (and other caregivers) have nearly illegible handwriting. That wastes other people's (highly paid) time, especially when those illegible notes are orders for other people. This may also allow a way to "diagnosis check" the notes, raising warnings when something nonsensical is entered in the chart. For instance, if a patient comes in for debridement of a decubitus on the right foot, mention of the left foot should raise a warning.
> That's a ridiculous suggestion!
No, that's just a hard suggestion. Since it is hard to do, you feel justified in telling them what they can and cannot charge, under threat of jail?
Oooookay.....
I am for the complete Trantorization of Earth.
For example, when my gf had to get her records transfered recently, it took 3 months of going back and forth between the two clinics (one 300 miles away) to finally get them faxed. I don't know why it took so long, but it seems that it usually does. It would be nice if we could avoid that hassle.
Then there is the setting up of meetings. Online scheduling makes things much easier -- especially if you have more access than free phone time at work (or if you don't want people to hear you). They should be able to schedule their appointment with you, get an email verification, and an email reminder.
Prescription refills. If it is for something the doctor has every intention to refill, and does not need to see the client, then allow web-based refill requests instead of phone-calls.
So you can't show the entire medical file to your patient. What if they want a second opinion. Maintain a database of verified practioneers, and allow the patient to forward a file to any doctor in the list. Preferably, if their family doctor (out-of-town doctor, etc) is not listed, that would be rectified the first time the patient signs in.
Realistically, patients (at least /.ers) was full access to their records. Though that is not currently an option, perhaps you should focus part of your attention towards that end as well. As long as part of the records are being kept from the patient, the patients will never fully trust the doctor -- because the doctor is obviously hidding something from them. When I called around to every clinic/hospital in my area (Portland, OR) when I was about to run out of medication (I had moved, my doctor was no longer local) -- and nobody was even willing to tell me what to EXPECT (side effects etc) when I ran out of meds (Asacol. Didn't have health insurance at the time and new Doctors would not see my and just accept my recent records from a previous doctor. They wanted me to go through a $fullexam) -- what did it do? It convinced me that they were ripping me off and that I didn't need the meds and that they were all quacks. I had been told I had to take the meds every day for the rest of my life, and I have not taken any for a couple years -- with no side effects... Perhaps they were just lying to me to take my money.... ANYWAYS, the anecdotal thing was an example why hiding records from patients make them feel untrusting of you... You should attempt to take that into account as well.
http://www.google.com/profiles/malachid
I find it disturbing that some people that use this site automatically assume they are the only type of person on here. In this case, a doctor is asking the advice of a technically knowledgable group of individuals, all of whom use the internet a fair amount, about what kind of services they think would be useful, feasible, and of benefit. I think it's naive for people to believe because they may not go to the doctor very often, if at all, that no one else who reads /. does. Personally, I am not heavy into hacking... my open source experience is limited to tinkering w/ Linux on occasion. But I do read /. because it has a lot of intersting tech links. I'm sure I'm not the only one like this, so I represent a portion of the /. community. I visit doctors fairly often, I've lead an active lifestyle and occasionally have to pay for it with injuries that require medical attention. I think this is a useful idea this doctor is inquiring about.
Having said that, here's my two cents. Obviously the most important thing will be security if you are planning on any sort of interactive features. A BB would be good, as would online scheduling of appts. I would also want an online database of common and not-so-common injuries/illnesses/procedures. Often doctors give patients pamphlets about what injuries they have, and what procedures they are doing. You can only collect so many of those things. If they were all indexed online that would be convenient. In the end, minimizing the amount of confidential info available is the best way to go. This would be in the best interests of the patient.
House calls.
Flout 'em and scout 'em,
and scout 'em and flout 'em;
Flout 'em and scout 'em,
and scout 'em and flout 'em;
Thought is free. - Shakespeare [The Tempest]
1. Good medical attention, and
2. For my personal records to stay private.
Anti-semitism only adds to the problem of hatred and intolerance already prevalent in our society.
We must forever remain aware of, and guard against what such hatred caused in the 20th century: the century of the greatest bloodshed in human history.
I have to say, while there may be some remote truth to this type of retoric and cynacism, I don't think it is fair to caractorize all doctors this way. It isn't any more fair then saying all lawyers are dishonest, or that all politicians are unethical.
I happen to know several ethical doctors and lawyers personally, and they tend to be the crux of society, not part of society's gutter.
Doctors have the right to earn a wage for the services they render, just like anyone else. Doctors provide an invaluable service to the community. Your ignorant diatribe is disturbing.
To the question at hand, I would harp that which has already been suggested: security, security, security. Most of the other benifits of the technology you propose should naturally fall into place, but security is a notable exception to this rule, and requires your full attention.
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Kurt A. Mueller
kurtm3@bigfoot.com
PGP key id:0x75D2DCCD
Lawrence Lessig is my personal hero.
This is a great idea...always has been, but there is NO easy solution to any of the problems that are being brought up. - Security...who as access to what? As soon as you limit access to a record to a certain doctor, chances are that that doctor will NEED to see that record, but won't have access. - People keep saying they want access to "their" records. Folks the medical records that have your names on them do not belong to you. They legally belong to the hospital where they reside. You cannot just walk into the records department and take your records. You can ask for a copy, but you can't take the original record. - Wireless is a bad idea, if anything is going to be networked it better be wired. - PDA's are a bad idea. Doctors are notorious for losing things. What happens when they lose their palm device that just happens to have 100 patient's records on them? Can you say lawsuit? - What about HIPPA requirements? Jacao (sp?) audits? All of this stuff HAS to follow their rules or else its goodbye practice. - Computers in all the rooms could be a bad idea. Too easy for little Johnny to get into the computer. Doctors don't like to log off things like this. They log in and then walk away. So you say fine...just keep track of who does what? Doctors also hate to remember their own passwords and login names so they will all find whoever has the shortest one and they will all use his. We have been working with hospitals to figure out this security stuff...currently we have database level group security (certain groups of users have access to certain databases of data). Next up is document level security, but that is even more difficult. Some of you wondered why hospitals don't take more advantage of the latest technology? The reason is cost. The majority of these hospitals have NO money at all.
as a geekgirl with many medical problems, having online access to my medical records would be a godsend!
:)
a bulletin board would also be an excellent idea. i would love to be able to post questions and have my doctor answer them. heaven knows how many questions i forget to ask when i'm actually at the office.
Hash: SHA1
I work for a company that does just what you're asking. Go take a look at www.medscape.com. I'm one of the UNIX Administrators and we offer products right along these lines.
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I would check out http://www.healinx.com they offer a free service for secure communication between doctors and patients. I even heard that some plan is reimbursing their webVisits -- an online, secure structured consultation.
1) If you are planning on using the web to let patients see charts and other portions of their medical records, you have *GOT* to make sure that you are using SSL to prevent sniffing of the data.
2) you need to make sure that patients cannot access each other's records by simply changing the patient identification number (or SS#) in the URL. Mistakes like this are *VERY* common in web development, and you don't want to get slapped with a HIPAA audit because your developers didn't grok the magnitude of the problem.
3) Don't allow your developers to give users a "save my password" (i.e. save a permenant cookie on their PC) option; cookies should expire within an hour, and users should have to log in each time they access their data. (I know that seems like a pain to some users, but it is worth the effort. I'd wager that they *will* check their records from work, and that co-workers *will* check those same records if you don't force the use of a username and password every time)
I don't think you want your doctor to charge by time, unless you have so much money you've forgotten about the Real World. If they charge by time, are you going to mention that strange pain you sometimes feel in your left arm?
-Paul Komarek
I just had a long conversation with my Mom on this very subject. She's been a nurse going on 30 years now, and is very, very good at what she does. She, and most of her co-workers, like information technology... just not how it's implemented.
1) Paying attention to workflow in a medical setting is =key.= Life and death decisions are made based on the accuracy of the data in the system. If the system is difficult or unweildy to use, the care providers won't be able to make proper use of it.
Have your developers follow around your nurses, therapists and physicians. Have them carefully note how things are done now, and why. There may be some pre-packaged software that will work fine... but there might not be. Or you may have to modify it heavily to meet your user's needs.
The little details count for a lot of productivity. For instance: when checking off lab tests to be run, the care provided may have to go through sixteen screens to pick what she wants to run, and might miss one, or include another by accident! If she could check off a "test suite," or bundle of the most common tests run in a certain situation, labor is saved and lifesaving accuracy is increased.
Ask your nurses what they want and need, and =listen= to them!
2) Accordingly, you should budget most of your money on software and development.
3) Go to a "thin client" model... wireless PDAs that talk to fault-tolerant, high-availability servers locked in a backroom only the Chief Geek has the key to. In an environment as hectic and fast paced as a medical establishment, you want the "hot water" data model. The servers are the "hot water heaters", and the PDAs are the "faucets." Whenever a nurse or doctor walks into a room with her PDA, she has data on-tap, hot water. When the battery begins to run down, she grabs another one from the recharging cradles, logs in, and has "hot water," or the same data she was just working with.
This will work with fixed systems at the bedside (like notebooks), but you'll have a problem with people forgetting to log out, etc. Look into a "key-card" access system instead of a traditional login if you go with fixed systems in every room.
The fewer things run on local PCs or workstations, the fewer things your administrators will have to configure and maintain. This translates to higher security and uptime.
Running a medical facility is a much more complex and critical undertaking than running a web site or ISP. Lives =are= on the line. Engineer your site for 1) practicality, 2) utility and 3) robustness.
SoupIsGood Food
Well as I'm not married, none, But I can think of cases where you would want to. For example if you were having an afair and picked up some sort of VD you might not want your spouse to know.
Now I think that would be very unethical on several levels, but it is the best example I can think up now.
Erlang Developer and podcaster
new adult medicine clinic
You mean nude doctors and nurses?
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Men with no respect for life must never be allowed to control the ultimate instruments of death.
GW Bu
XML is a lovely thing but let it get a bit more established before we go dropping the existing standards. I don't know of many systems that accept XML right now.
I don't read ACs: If a post isn't worth so much as a nom de plume to its author then I wont bother either.
n'ces't pa?
You'll need all kinds of special safety certification for all of the in room equipment, right? That sounds to be the most expensive part of the whole deal.
Of course, there are privacy implications, so you'd want it to be opt-in - and you'd have to be extra paranoid about security.
Any sufficiently advanced technology is indistinguishable from a rigged demo
--Andy Finkel (J. Klass?)
My friends know me for my love of unnecessairy technology gadgets, so I certainly am techno-phil. It's my private hobby and I enjoy it.
But seriously, in your case, it sounds to me as if you are trying to set up all this stuff just because it's cool, not because it is actually needed. Does this really give a benefit to your patients? How soon will this stuff be outdated?
You should seriously reconsider how far you want to go with techno-gadgetry. You might end up working too much on keeping your network working and not having time to work with your patients...
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You may like my a cappella music
Jim Clark's medical information company before
merger with WebMD had this business model.
Jim Clark found SGI and Netscape.
Healtheon/WebMD is still floundering.
This ain't gonna happen. I write/maintain scheduling software, and one thing I have learned is that, in order to max their productivity, the docs multiple book several appointments at a time. In other words, if you have an appointment for 9:00, there are several other people who also have an appointment (with the same doctor) at 9:00.
The doctors are expensive to run, sort of like expensive processors. You have 'em multitask in order to keep 100% utilization. That way, if a patient cancels, the doc doesn't go idle. The side effect is that even when the job is ready, it still doesn't get full use of the processor.
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As copyright owner of this comment, I authorize everyone to defeat any technological measure which limits access to it.
A trend in some parts of the medical world is 'shared experiances'. think AA meetings, but without the alcoholism :)
.. Also it can be a great comfort to know your 'not alone'.
A forum where people with a certain experiance can share thoughts, fears, experiances, can be a big help for someone who is 'new' to the situation. It can be a great relief to hear ppl are living normal lives with bad alergies
Ofcource pls do make sure troll's dont find a place on forums like that, that could lead to very hurtfull experiances.
-- Chris Chabot
"I dont suffer from insanity, i enjoy every minute of it!"
For everyone who seems to think that this is doctors wasting their patients' money or time, I can tell you from experience that a paperless office would be an incredible improvement for almost any medical center.
I worked in a hepatology (liver disease) clinic for a while, and was responsible for filing all the lab reports and other patient information that came into the office. We would get several hundred, sometimes almost a thousand, different sheets of paper a day. All of these had to be sorted and placed in the patient's chart (If the chart was even in the office. Oftentimes it would've been set out in any of a dozen different places). Based on the volume and the fact that I was only there part-time, there were some labs that didn't get filed until weeks after they were received.
In most clinics, the paperwork can come close to burying people. There's vast amounts of information passing through, most of it unnecessary and a lot of it being misplaced. An electronic system would not only save a lot of paper, but a lot of headaches and would expedite many areas of doctor-patient information exhange.
Not only are you good to want this, but there is an extra twist (in the US). A doctor cannot divulge information to a third party that would indicate that the patient is in fact a patient. Heavy fines, possible jail time, etc. if this is not met.
-George
Jesus was all right but his disciples were thick and ordinary. -John Lennon
Good idea, but with some problems. All spelled with $$$.
Yes, it seems to everyone that doctors are rich SOBs who hardly work for a living. I have that opinion, and I work with 7 of them:) But seriously, profit margins are very tight amongst primary care doctors, especially in CA and MA. The money is barely there to hire competent physicians, and there is even less to hire competent computer folks.
Now, if patients (or, often as not, their insurance companies) would pay a reasonable rate for services rendered, this would be possible. Unfortunately, the trend over the past five years, and into the forseeable future, is for less money to be paid to doctor's.
Take a normal cold/flu visit. Takes about 15 minutes. Charge (in this office) is $45. Sounds like a lot, but that is only $180 per hour. That has to pay for insurance, staff, rent, and the doctor's salary. Still, after figuring overhead, it winds up in the neighborhood of around $100 for the doc. Except that no doctor (primary care, mind you, in the US) ever sees more than about $130. It's the insurance company cap on what they will pay (this is MD, folks. Might be better or worse elsewhere). But the costs didn't go down. Now the doc is taking home around $50 per hour.
Now, let's here from all the consultants (computer) who would do that. Better yet, let's take $25 per hour (probably not a terribly capable and/or competent computer type) to run the doc's computers. Now the doc is making $25 per hour. Time to go sell shoes.
Not to blast you, but rather the US medical system. Computers do help (we are on the slow march to a completely electronic record) and the long term costs are LOWER with computers. But getting over that short term hump is a serious pain.
Jesus was all right but his disciples were thick and ordinary. -John Lennon
I work for a 7 person primary care group in the United States, and we have addressed many of these issues.
First, as has been stated elsewhere, is security. I don't think it needs to be expanded upon. If you haven't already grokked this point, stop everything else.
Second is money. I'm not sure what you specialty is, your payer mix, your clinical setting, or anything else, but each of these affects how much money will be available to you. Most of the commercial solutions are big money with big service contracts and big maintenance requirements.
I cannot stress this enough: beware the vendors! I started work here after the EMR had been pronounced 'live' by the vendors. To tell the truth, it wasn't live until at least 15 months after I started working.
Your idea for computers in every exam room is a good one. We found that they were much cheaper than wireless solutions, and are proving much more sturdy in the long run. Most important to our head of medicine, they are MUCH faster. You just can't compare 100Base-T to 802.11. There's also the fact that the wires are more secure (IMNSHO).
Hire a lawyer. Look into the legality of sending patient emails. This is beyond security. The laws are vague. Imagine this scenario (places made up): you live in Ohio. Your practice is in West Virginia, and that is where you are licensed. Your patient lives in Pennsylvania. You sit at home at night and compose an email telling Ms. Smith that her strep culture was positive and that she should continue taking the amox. You send the email from your machine in Ohio, it uses the SMTP server in your practice in WVa., gets bounced through a router in Va, and winds up in Pennsylvania.
While you and I, and the rest of slashdot think nothing of this, the district attorneys in Ohio, Virginia, and Pennsylvania can now sue you for practicing medicine in their state without a license. There is not really any merit to the case, but that might be over the heads of: the DA, the judge, and the jury of your 'peers'.
Rather than full pt. access to charts, I would think to implement a fax back system. IOW, Mr. Jones wants to see his last three cholesterol test results. He emails/web-forms a request. This goes into your system, and the machine emails or faxes back the requested information to whatever email or fax address Mr. Jones has on file. This must be filed in person, in writing. Mr. Jones must also sign a waiver saying that by having this service (faxback of results) available to him, there is the possibility of this information falling into the wrong hands. IANAL, but this is the view that my practice has taken.
Beware IM's. First is the possibility of hijacking a nick. Second, if a patient IM's you instead of calling your answering service, you will be more liable if his chest pains are a heart attack, and not indigestion. Opens up a world of liability.
If you must email, insist upon crypto. It's the only chance of being sure of identities (both ways).
Back to the money question: while video conferencing might be nice, how many of your patients will have access to DSL/cable? How much time will be spent doing that, when you can spend some time doing a flesh and blood visit? Which has more value to the patient? Can you code a visit for a teleconference? Can you get reimbursed, even if you pick the correct code?
Much of this is directed to primary care, but that's where I work. Naturally, you'll have to answer a lot of these questions for yourself. Unfortunately, the technical answers are the easiest to get, yet they are the most trivial. What you need most is legal and business help. Most of the legal concerns would be zero if you used a telephone or letter. But many aspiring young ADAs are trying to catapult themselves into the limelight with computer cases. And don't forget that all of these toys must pay for themselves in one way or another. The best people to ask are not techies who want to play with cool new toys. The best ones to ask are your patients.
And they will surprise you. In our office, the oldest, least educated are often the most interested in having a computer in the exam room. They have been more patient with working bugs out.
Above all, keep this in mind: do it to improve patient care. That must be the end result. If it is not, your are wasting your time.
Jesus was all right but his disciples were thick and ordinary. -John Lennon
Computerizing the food system would help quite a bit, especially for people who are allergic to eggs, peanuts, and the other food that we throw in just about everything.
The computer keeps a standard menu on hand, and tracks ingredients. The dietician says how many calories, when, and what limits the patient has upon them. The patient then can make a choice (from what they're limited to), and the kitchen does up the order.
Whomever takes the dirty dishes back can note how much the patient ate. You're then on the way to tracking caloric intake, nutrition, etc. etc.
Gimme a break! MD, MPH, AOA, credential, credential, blah blah blah. Most docs view the MPH as a joke. A throw-away degree for people who still can't decide what they want to do in medicine, or for those self righteous types. But it's only partially true. You've got a jaundiced eye on this subject and a little humility would serve you well. Your inexperience in the real world of medicine shows.
All the freakin irq channels on sickle cell anemia isn't going to cure it, and the money that went into the hospital chat rooms are sure as hell better served ELSEHWERE.
Lesson two, from someome who's been in your shoes. Our goal is to treat the patients, not the disease. The whole patient, body and mind. Support groups, irq or otherwise, further that goal. And an irq server can be assembled for less money than it takes to perform a single MRI scan. Lose the tunnel vision.
Reality check for you--health care is already a significant portion of the US's national expenditure (steadily well over 10%, I think approaching 20% as of 2 years ago). The money could well be used elsewhere.
Tautological thinking like that doesn't advance your argument. Defense money could be spent on the arts. Money for the arts could be spent on roads. Ad infinitum.
For example, computerized patient records (CPRs) have been shown to *reduce* cost of care--they save on cost of paper, time to search records, and lower the chances of film and patient records being lost (which resulted in lab work and imagery (xrays) to be redone)).
./ers did. One doc friend of mine does custom dsp programming and is starting a medical device business based on this. Another employs about a hundred people in a software company he founded with his own code he hacked together while burning the midnight oil for a year. Many come from engineering and other technical degrees. I hate to see people painting the profession with such broad strokes.
I agree. Several of the hospitals I practice in are completely computerized - charts & xrays included. They are very convenient and can save time when properly implemented. And time is our most precious resource. But I don't think they should ever be placed online. It's just not necessary. Secure transmission of medical data between offices and hospitals - yes. Open to the general public with passwords - no. If a patient wants to read their chart, it's worth the effort to stop by the office and not have to worry about millions of people inadvertantly learning the intimate details of their health.
And another misconception that must be put to rest is that all docs are technically clueless. The fact is that docs are perfectly capable of programming computers as much as anyone else. I started programming my vic-20 about 20 years ago and haven't stopped. C,C++, Pascal, FORTRAN, lisp, tcl, perl, Java, etc. I moved from TRS-80 -> VAX -> Mac -> Sparc -> Linux, like a lot of other
On time is a worthy goal. But there are so many unforseen events - somebody is sicker than expected and requires more time - a couple trips to the emergency room - incessant phone calls from "utilization review" people wanting you to explain in excruciating detail what you did or plan to do and why - etc. There really are a lot more unforseen and pressing events coming from all directions that can put you behind schedule. More so than in any profession I can think of. And if we are only 2/3 the way through your history and examination when your allotted time expires, should we say "time's up, I'm off to the next patient"? That being said, I agree that we should try our best to minimize the wait since because it is the considerate thing to do.
For example, if the neural net predicts that someone is going to make a full recovery in 5 days, send them home now with a living assistant.
It just isn't that simple in a vast number of cases. You aren't admitted to the hospital these days unless there is some very real concern for your health, or you are being admitted for a procedure. The optimizations you are talking about have already been made inside the neural networks we carry in our heads. The extra time in the hospital has been squeezed out already. If a procedure can be done outpatient, it is already being done that way. Now we are in a position where we know many patients are being sent home too early because the system has become so obsessed with efficiency.
If you are actually dealing with a sick patient, your neural network is about as effective at predicting 5 days into that patient's future as it would be predicting the weather 5 days out. The consequences of an incorrect weather prediction are that you get a little wet. The consequences of sending someone home who was too sick to go home (but the neural net said it was 'OK') are not so good. There are way too many intangibles that these neural nets do not take into account. Just the very 'look' of a patient conveys very important information that current neural net implementations are completely oblivious to.
Medical Information doubles every 8 years, *and* in that 8 years, 1/2 of what you knew 8 years ago was proven wrong.
That's a bit overstated. Most aspects of practice are no different today than they were 8 years ago. Real medical progress that is applicable to patient care actually advances quite slowly. I agree wholeheartedly with all of your other points.
First, you'll have to excuse me for posting something that many may see as self-serving. But I really hope that some of the products that my company provides might help Bolus reach his goal. My company is Data Critical, we specialize in wireless and internet solutions for healthcare. I'm not as versed on our products as I could be, being that I am just a lowly webmaster. but in a nut shell, we have a couple of products that I think would be perfect for this sort of application. First, our WebChart product is a web-based charting system for patient data. Complimentary to that is PocketChart, a WindowsCE program you can use while interacting with patients, then upload the data into WebChart. (We demo with the Compaq iPAQ, and Cisco wireless products.) All data is sent securely, that's something we've been trying VERY hard to ensure. We know that this is people's chief concern. We have other products as well, but I don't know very much about them ... more for hospitals than anything else.
If anyone is interested, shoot me an e-mail, and I'll put you in touch with someone that can give you more information.
The UW Medical Center (an UW Physicians Network, where my wife works) are already paperless when it comes to patient charting. It's all electronic. The UWMC is using some of our products, while the UWPN is using a different product. So don't fret ... what you want IS possible, and is being done.
I can't believe nobody's posted that yet (at my threshold.)
I have seen many posts here questioning whether an EMR will improve patient care. The simple answer is this.
If it is well designed and easy to use, then most definitely yes.
If it is poorly designed and hard to use, then most definitely no.
Almost 1/2 of what a physician does these days is paperwork. You must document every detail of the patient encounter. You must then look up the code for your diagnoses. (Did you know there is a code for being hit with space debris? Yep. There is.) These code books are huge. The more of a generalist you are (Family Practice, Internal Medicine, Pediatrics, Emergency Medicine), the wider the set of possible codes you will use regularly will be. Computers are great at finding this stuff and coding it for you.
Prescriptions. Man, there are so many freaking drugs, and so many drug interactions, it boggles the mind. What better way to keep track of things like doses, dosage forms, and drug interactions than a computer?
Computerized medical information would also be helpful in an EMR. Your doctor doesn't know everything. It's humanly impossible. Medical Information doubles every 8 years, *and* in that 8 years, 1/2 of what you knew 8 years ago was proven wrong. That is the kind of database that your physician deals with every day. To put that stat in prospective, On the day you start medical school to the day you finish residency (averages 8 years), there is now twice as much stuff, and half of what you knew is now wrong. And you're just getting started.
And to those of you bitching about the money a doc makes, let me remind you it isn't the truckloads you imagine. Medicine in the U.S. takes approximately 12 years of higher education. 4 years university, 4 years medical school, 4 years residency. The first 4, you might have a job at Arby's or something. Not a lot of income there. The second 4, you probably don't have any paycheck, and you're adding at least $20k in debt per year on top of whatever you were in for undergrad. The third 4, you're getting paid - but only about 35-45k per year. That sounds like a good chunk of change, until you compare it to the hourly wage, and then realize that you're only making about 3 dollars an hour. Once you finally get into the real world, if you're in a general specialty, you're looking at a paycheck of about 150k - which if you're lucky is slightly more than the amount of debt you are facing. Oh, and you're 30 years old now.
People aren't physicians because they want to make truckloads of money. It's better to pursue a business career for that. Physicians want to make some money for their SERVICE, for that is what Health Care is - a service industry. You pay us to give you the best health care advice possible. It's up to you how much you are willing to pay for that, and how you use that information.
Linux - Because Mommy taught me to Share.
I am considerably more expensive by the hour than my doctor. Like by a factor of 4. My being idle frequently idles other people as well. I have more or less equivalent education, and my skills are probably rarer. I don't double-book appointments.
Good variables might be the error in the start time of the exam (Visit_planned - Visit_actual) as well as the duration (probably track the type of visit with the duration since certain types of visits probably always take longer)
Then produce standard Xbar, R SPC charts and use them to adjust patient scheduling.
SuperID
SPC isn't just for machine shops :)
--
assert(expired(knowledge));
In fact, I can think of some people that would pay me to find your records online.
Click here for $50!
If you intend to be connected to the net and have patient records online, be sure to have a solid firewall. Also, with computers in every room, there are going to be unattended computers some of the time. Run an OS with decent security and auditing to protect patient confidentiality.
The net will not be what we demand, but what we make it. Build it well.
A search engine to find another doctor?
Hey,
The only thing left to computerize is the one thing that can't be (totally) automated, the doctoring. However, artificial neural nets are fairly effective (99.99899%) in predicting how well patients will recover, and what kinds of specific things they will/won't be able to do. The process is quite frightening actually. A company that I know of is doing this, check them out at http://www.arcon-inc.com.
Also, once this is established, doctors and patients can both save money. For example, if the neural net predicts that someone is going to make a full recovery in 5 days, send them home now with a living assistant. This saves you money for obvious reason, and saves them money. After a certain number of days in a hospital, the likelihood of getting a new disease becomes almost certainty. But I digress.
Eventhough the company I mentions earlier is on windows, it is worth checking out.
Aren't computers cool?
Good Luck
--Alex FIshman
T-1s are, in general, fuckin' expensive. You may wish to look at SDSL or some other form of xDSL for that amount of bandwidth for (again, generally) much, much less cost. True the T-1 can be more reliable, but since the only things you should be sending out across the wire are non-critical things like "hello bob, your appt. is at 11 am tomorrow" you can probably deal with some downtime. Another alternative is to get something cheap for the officewan bandwidth like a cable modem (hey, free waiting room cable), or low end xDSL, and do your serving from colocation. Especially if the local hospital has a server room you could cut a deal with.
Good luck!
--
Fuck Censorship.
News for Geeks in Austin, TX
Bottom line is: Pull your self-important head out of your self-important ass and realize that you are not alone in this world. People don't exist to serve you. I can just see you getting out of your car in a traffic jam screaming at everyone "Get the hell out of my way! I make more money than you and you are costing me profits!"
rr
Quidquid latine dictum sit, altum videtur.
rr
Quidquid latine dictum sit, altum videtur.
Given that workplace email has zero expectation of privacy, I would not use it for sensitive personal stuff. Not that public email servers are all that secure, but they'll do for mildly sensitive things like "Your turn to bring the Bundt cake to the next Elders of Zion" meeting.
Anyway, you should give medical office workers some credit for discretion. At least I hope they already know not to give sensitive information to phone receptionists!
__________________
If you're so healthy that you can resolve all your health issues in a 15-minute appointment, more power to you. But some of us have chronic problems, and have to do a lot of back-and-forth with our doctors. If you have a lot of complicated information to exchange, office visits are expensive and inconvenient, and the existing alternatives (voice mail, faxes) are slow, clumsy, and subject to garbling.
The big risk with email is that doctors might be besieged by lengthy messages from all their patients. That's probably best anticipated by carefully educating patients before handing out email addresses.
__________________
This is slightly off topic, but there's currently a bit of a debate raging here in Australia about the security and privacy issues surrounding online medical records. Basically the AMA is trying to put all records online so that doctors and hospitals can get access to them when you e.g. change physician, go to a doctor "out of town", and (I suppose) for emergency situations in hospital ERs. I'm not sure where I stand on the issue yet. Clearly it could be of great practical benefit when used for the reasons for which it's intended. But, like many others, I'm pretty concerned about the security problems associated with it.
"No Neal, after you" - Buzz Aldrin
- What can the 'net do to improve your transcription/dictation process? Digital dictation: audio securely transmitted to off-site transcriptionists, text securely e-mailed back, etc.
- It can help doctors and patients both if doctors could access films/MRIs from home. Think about those late-night calls when you wish you could see that x-ray again before making a recommendation or prescription over the phone.
- Heck, extend the above to accessing your full patient records and charts from home. This would really help on-call docs make better decisions, especially when the caller is another doc's patient.
- In addition to allowing patients to see a list of available appointment slots before calling, good scheduling software could be used to help generate statistics on the promptness of appointments and average wait times. This could streamline the patient experience by helping you identify places where your schedules tend to fall behind, thus helping you make allowances for them in the future.
- Hire a web jockey (hey, I'll offer...) to put together web pages and links to information about the conditions you treat. Have terminals available in your lobby for patients to review this info and/or email parts of it to themself. This information could me much more complete and interactive than those ubiquitous "about your condition" pamphlets. Just review the content yourself because there's so much crap on the web these days...
Hope these suggestions inspire thought, good luck with your new office!I stole this sig from someone cleverer than me.
These are just some of what I can think of, since this is a brainstorming question. I think an overall theme of my list is to keep some of the more tedious things on-line, and try not to impersonalize the face-to-face things. Most importantly, if this could somehow streamline the waiting time, it would be appreciated.
----------------------
Maybe you can find some useful tips browsing the Healtheon web site - those guys probably asked themselves similar questions.
I'm a diabetic. Although I can not order insulin online (it is only available on prescription), I can order blood-sugar tests, needles and other supplies at Hermedico in the Netherlands. They send me the stuff in my office and charge it immediately to my health insurance. It is one of the online services which I rely on and the have not let me down yet
If can get some of these services together, not only would you help your patients, you could also use the feature to get more traffic to your site, thus getting more potential new custommers.Sig (appended to the end of comments I post, 54 chars)
A clinic where patients did not wait more than 15 minutes from the time of arrival to see the doctor
A clinic where appointments were not scheduled so tightly that nurses have to explain diagnoses and prescriptions because the doctors are already on to the next patients
A clinic where doctors address patients at the same level of formality which they expect (i.e. don't call my 75-year-old mom Millie but get huffy when she calls you Dave)
A clinic where I'm allowed to read my own medical records and obtain copies
A clinic which will see me even though I'm self-insured (i.e. I pay my entire cost because I don't have health insurance)
A clinic which places more emphasis on patient care than on whizbang technological innovation - or at least where the doctors appear to care more about patients than about their tech.
I find it really hard to believe that doctors will enter their own case notes on the computers in the exam rooms. That's what $8-an-hour receptionists and fileworkers are for. Seeing a computer in an exam room (especially one on which we cannot check my e-mail during the 40 minutes we're waiting dressed only in a flimsy gaping robe) and all the other fancy stuff will only make your patients think "I wonder how much I'm being overcharged for this?"
A groupware calendar patient/doctor shared so the patient can document symptoms and the doctor can interactivly track and maintain the patient. The opportunity to create a small community on the web revolving around this medical practice could be enhanced by the web but dont expect it to dazzle the patients into wellness, the idea here should be tools to make your job easier and better not "shiny things that would mezmorize a two year old" unless you're treating two year olds who are in need of shiny things that is.
First of all:
Make it secure...
No wait,
make it really secure....
My medical data, accessible from the Net, that could be a major problem. (for you and me)
Hello Bolus: Why should we know what functionality your patients want? They are your patients; why don't you ask them? Are you implying that "geeks" are sickly by nature and therfore more in touch with what patients really want?
My advice to you Bolus is to abandon your system development effort right now -- save yourself some money; you clearly don't know what you want to build so don't start building.
Remember: Although we geeks are savvier these days (we will charge you outrageous rates to build your system using free software), we still don't do strategic consulting on the medical field.
If you want someone to dictate your system requirements to you, try a bunch of overpriced MBAs.... I hear they are being laid off by the dozens by consulting companies across this great nation of ours.....
I am an Australian Doctor. I have dabbled with this very idea for some time. The infrastructure in the rooms is no problem but as mentioned above my biggest concern is security. My home computers currently live behind a series of firewalls etc everything is double encryted and deleted files are shredded 30 times. Even with all this I still would not be happy to put someones Medical records online. The medico-legal nightmare of someones AIDS test results whatever they are becoming public scares the hell out of me. If you don't know more about your computers and network than the highly paid so called "expert" consultant who has promised you the world DON'T do it. Put your static facts sheets and other general patient information online ( on a CD not hard drive), run a Mac(my bias but I think still the most secure) keep your server right in front of you in a locked cabinet or room. Security is only as good as the weakest link. If you don't want the whole world to see it(all your patients files) Don't put it online. Sorry for the downer psquared@thedr.com.au
Damn good Internet security.
© Copyright 2000 Kristian Köhntopp
All rights reserved.
Security Security Security.
I'm currently a 4th year medical student that is doing an independent project on Electronic Medical Records (EMRs) and what I have seen so far scares me.
Medicine as a whole has an absolutely horrid track record embracing business technologies. Inventory Control is a good example. You and I both know that I could walk into your hospital and walk out with a Cath Tray, and no one would be the wiser. Keeping this in mind, you aren't going to have much local help setting up and/or maintaining your setup.
Second, make it secure. Very secure. As in don't even connect it to the internet. You should be under the assumption that if it is on the internet, someone has already seen it.
If you want to keep your EMR from being hacked, don't have them on machines that can access the internet. Don't have machines that can access the internet access the EMR. It's that simple.
Once someone (insurance company, employee's corporation) hacks your system and gets data about your patient, you have violated their privacy, and there is absolutely no way that you can ever restore it. And believe me, Insurance Companies have a large incentive to find out who the financial bad apples are and remove them from the system.
Don't connect it to the internet. Don't allow internet accessible machines to access your medical records. Understand that these are two separate things.
EMRs have already been hacked at institutions that will have a much larger budget than you.
Feel free to email me - miracle at procyon dot com if you want to discuss the matter further. I'vee travelled the country this year interviewing for residencies, and I assure you this problem is nation wide.
Linux - Because Mommy taught me to Share.
I write/maintain scheduling software, and one thing I have learned is that, in order to max their productivity, the docs multiple book several appointments at a time.
This is only necessarily true if 100% of a doctor's work requires a time slot.
The truth is that it need not be the case. There are a lot of things that can be done at almost any time: email, telephone calls, paperwork, evaluating test results, journal reading, and so on. If they actually end up with a few spare minutes when somebody skips an appointment or doesn't take so long, other work could fill in.
According to a very interesting article in the New York Times on Jan 4 called "Remedy for Waiting", some clinics have redone their scheduling to serve the same number of people with the same doctors without the standard technique of massive overbooking. The article is now in the for-pay archives, so I can't quote from it, but it made a convincing case that it was doable. People were stunned when they could get an appointment the same week and actually be seen on time.
I agree with the original poster in this thread; the #1 thing I want is knowing that I don't have to wait six months to see a doctor, and where I don't have to spend two hours reading copies of "People" from the late 70s.
What? You mean you didn't bring your laptop with you?
Say no to software patents.
If there is to be any involvement with the internet then I suggest your number one priority be security. You don't want people leaking confidential data about your patients.
AussiePenguin
Melbourne, Australia
ICQ 19255837
Jeremy
Melbourne, Australia
Jabber Australia
A game LAN set up in the waiting room with Counterstrike.
"My doctor's ready to see me? But I've only been here ummm...four hours. Couldn't he let someone in ahead of me?"
--
Should we really be supporting this kind of behaviour? These guys don't want to talk about any real uses of technology in medicine, like for curing people. They just want to pad their fees in order to squeeze yet more $$$ out of the insurance industry, which will then have to cover its costs, so some poor schmuck gets his coverage cut. Everyone's down on lawyers, but we're freakin' little league parasites compared to this kind of doctor.
-- the most controversial site on the Web
Will my doctor be a 1337 RX0R?
microsoftword.mp3 - it doesn't care that they're not words...
Many people do not want their spouse or empolyer to know things about their medical history. And at many offices the employer can in theory look at your email. If you were to email someone something you could create some delicate situations or even get someone fired or divorced.
Even just "Your appointment is next tuesday at 10:00" could cause problems if you are not a GP. I might not want my employer to know that I had an appointment with a Psycatrist or a specalist of one kind or another. There is still a major stigma attached to mental illness in many places.
Erlang Developer and podcaster
I don't read ACs: If a post isn't worth so much as a nom de plume to its author then I wont bother either.
I have a friend from high school. Brilliant kid from a brilliant family. He is now a brain surgeon. Said he does brains instead of hearts because the brain surgeons drive better cars.
He didn't go into medicine for the money, though. His brother is making 12 times the money as an attorney in Chicago. His family has a business he could have gone into and bought 5 Lexi [plural of Lexus?]
I met him for breakfast last year. At 8 am, he had been at the hospital for 2 hrs already with a patient. I wanted to buy him a cup of coffee, but he told me had had sworn off caffiene because he could not afford a tremor in his hand, no matter how slight. He got minimum 8 hrs sleep every night and had to give up woodworking [which he loved] so his hands weren't callused.
I would GIVE this guy a Lexus if I needed someone to put his hands in my brain: I would want him. Who the fuck wouldn't?
Ever see that commercial for the Discover card? Dad buying his daughter a dog, says the $600 beagle is too expensive. Asks about the $25 hyena, which in turn eats the store clerk. Dad thoughtfully reconsiders beagle. Tag line - some things are worth more.
I'm a lawyer, kids. If you have a transaction for $100 million and you will make $10 million, do you mind paying me $500 an hour to make it work? Not likely. You get what you pay for.
I do work for neighborhood merchants and my church for free. Not to mention my entire extended family. Not everything is money.
Pay no attention to the man behind the curtain with all your metadata.
Personally, everything else is secondary. I don't need to see my charts and meds on-line. Other doctors or specialists might, I don't need on-line video conferencing or email - and I doubt "you" would either. Why? There is a good chance that more time will be spent setting up/maintaining/playing/fixing/teaching the technology then helping the patient.
When I see a doctor-I want to physically see the doctor on time. If possible, give me a accurate diagnosis, then I can be on my way doing whatever I need to do to get better.
Or:
"I am a plutocratic [programmer] trying to make enough money to buy a fifth Lexus. Myself and a couple of other blood-sucking leeches had the idea of kitting out a [web site] with fancy-schmancy computerised bells and whistles so that we can jack up our already stratospheric fees into the ionosphere. We don't really have a clue about [making a profit], so we thought we'd ask a bunch of [consumers] what they'd like, and more importantly, be prepared to pay for. Meanwhile, malnourished kids and the homeless? Fuck 'em."
Get this straight: we are not each others' slaves. You were not born to be a slave to your fellow man. I was not born to be a slave to my fellow man. Doctors don't become doctors so they can be your personal nose wiper. If you don't wany to pay a doctor for medical help and advice, then go to medical school and you won't have to.
The fact is, you don't know jack crap. How many lives have you saved? Probably zero.
This habit of villainizing people who want something in return for what they do for others is just plain evil.
WHERE IS YOUR SENSE OF RECIPROCITY? Are you telling me that you wouldn't give a man who saved your life a Lexus is you could? Would you even give a "Thank you"?
The truth is, you probably wouldn't do anything if you could help it. People like you are the very reason people ask for money for what they do instead of accepting a vague promise to recipricate some time in the future. When you give money in return for a service, that person has some reasonable chance of being able to get something in return for what they did for you. When people say, "Hey, thanks. I'll have to help you out some day" they really mean, "thanks sucker."
I don't write this to be cynical. This is just the way it is. The fact is, paying someone for something they have made for you or done for you is the most sincere way you can tell them "thanks."